Responsible for the provision of complex patient accounting activity to facilitate efficient operations, expeditious reimbursement and optimal customer satisfaction.
Essential Duties and Responsibilities
- Is skilled in a range of processes, procedures and systems to carry out assigned tasks or has developed deep skills in a single area
- Understands the roles of all immediate team members and has a good understanding of how own team integrates with others
- Regularly provides guidance and support to more junior team members on challenging problems; helps them balance their workload and apply their skills
- Provides solutions to problems in situations that are atypical or occur infrequently based on practice and existing precedents
- Impacts the quality, timeliness and effectiveness of the team
- Uses discretion to modify work practices and processes (but not policies or procedures) to achieve results or improve efficiency
- Clearly and accurately conveys complex information
- Performs complex billing and collection activity including resolving complex claim edits and denied claims.
- Resolves complex patient issues and assists with questions on reimbursement.
- Participates and provides significant input for and assistance with the implementation of team-oriented process improvement initiatives.
- Provides solutions to problems in situations that are atypical or occur infrequently based on practice and existing precedents.
- Possess the ability to interpret and demonstrate compliance with third party contracts, regulations, guidelines, policies and procedures.
- Demonstrates "The Children's Way" values and behavioral standards.
- Review all assigned accounts to ensure that all information, codes, and other relevant information is correct and charges have been billed within guidelines.
- Edit and process claims efficiently, identify errors and/or rejects and resolve billing problems.
- Follow-up on all billed claims in a timely manner to ensure accurate, timely payment and disposition of account according to the payer contract or guidelines.
- Coordinates and consolidates payer specific reimbursement data to resolve denials and underpayments by payers.
- Follow-up with guarantors regarding account status; determine appropriate disposition of the account according to policies and procedures.
- Review and resolve credit balance accounts in a timely manner.
- Answer questions concerning complex procedures and serve as a resource to collection coordinators as needed, including on-the-job training for one to two processes or systems.
- High school diploma or equivalent, required
- Two-year Associate's degree or equivalent experience, required
Licenses & certifications
- HFMA Certified Revenue Cycle Representative, preferred
- Two to three years of healthcare experience, required
- Two years of customer service experience, required
- Knowledge of general procedures and guidelines used by health insurance companies, government agencies, employer benefit departments, and internal departments as they relate to billing and collections, required
- Excellent mathematical skills, computer skills, Microsoft applications and word processing programs skills and minimum of 40 words per minute, required
- Ability to develop and maintain productive working relationships to fully integrate within a team, required
- Proficient in English, written and verbal communication skills, required
Specific knowledge, skills, and abilities
- Maintain effectiveness when experiencing major changes in work responsibilities or environment; adjust effectively to work within new work structures, processes, requirements, or cultures.
- Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions.
- Ensure that the customer perspective is a driving force behind business decisions and activities; craft and implement service practices that meet customers' and own organization's needs.
- Develop and use collaborative relationships to facilitate the accomplishment of work goals.
- Identify and understand issues, problems, and opportunities; compare data from different sources to draw conclusions; use effective approaches for choosing a course of action or developing appropriate solutions; take action that is consistent with available facts, constraints, and probable consequences.
- Take prompt action to accomplish objectives; take action to achieve goals beyond what is required; be proactive.
- Deal effectively with others in an antagonistic situation; use appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
- Effectively manage one's time and resources to ensure that work is completed efficiently.
- Accomplish tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
- Set high standards of performance for self and others; assume responsibility and accountability for successfully completing assignments or tasks; self impose standards of excellence rather than having standards imposed.
- Assimilate and apply new job-related information in a timely manner.
- Clearly convey information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.