Accounts Receivable/Billing Representative- Ellis Preserve

Billing Department

·        Prepare and submit claims accurately with all required documentation on a timely basis to third party payers through electronic and/or manual billing processes in accordance with MLH Patient Accounting billing guidelines.

o   Review and appropriately resolve claim edits and rejections via XactiMed claims processing system, or forward to the designated department for resolution.

o   Review and process accounts identified requiring rebilling.

o   Maintain and monitor communication tools utilized for internal controls and/or external departments who have direct impact on the A/R.

o   Identify opportunities to resolve claim edits and increase clean claim acceptance rate through documentation and timely communication to Supervisor.

o   Notify Lead or Supervisor of potential system or process issues needing further resolution in a timely manner.

o   Document all activity/action clearly and concisely in the Patient Accounting and claims processing systems.

·        Remain current on all reimbursement terms/conditions, departmental procedures and applicable regulations.

o   Identify and report claim edit trends identified via Incompletes and Rejections affecting the claim clean acceptance rate

o   Identify and report internal system issues resulting in incorrect billing claim edits, reimbursement and/or contractual adjustments.

o   Identify and report internal department issues/trends on Hold in XM affecting timely claim submission and/or reimbursement by monitoring claims on weekly basis

·        Consistently meet productivity targets and quality assurance (QA) guidelines established by the Department.

·        Perform all other duties assigned, including but not limited to Correspondence / Mail / Customer Service Phone Forms

o   Follow up on all Insurance letters and phone calls, reopening accounts and forwarding to other departments as appropriate. 

o   Resolve disagreements with insurance companies and or their agencies.

o   Research returned checks for correct address and return to Supervisor within one week

o   Review the patient complaint phone form and respond within one working day for urgent requests and two working days for normal requests      

o   Perform any other duties assigned completely, accurately and timely

ACCOUNTS RECEIVABLE (EOB REVIEW)

·        Utilize daily payment ADHOC and/or Contract Management report to identify partially paid or denied claims on a timely basis

o   Review all insurance payment discrepancies and ensure accurate insurance and/or patient balances based on hospital- and payer-specific contractual agreements.

o   Utilize the correct transaction, responsibility and patient rep codes.

o   Document all activity/action clearly and concisely in the Patient Accounting System.

o   Notify Lead or Supervisor of potential system or process issues needing further resolution in a timely manner.

·        Submit internal department (i.e. Patient Access, Financial Counseling, Case Management) discrepancy/denial forms accurately and timely to appropriate representative or supervisor maintaining shared communication tool/report.

o   Perform insurance reverifications accurately and timely in the Patient Accounting system, and review balances after insurance changes to ensure accuracy.

o   Maintain shared communication tool/report with internal departments accurately and timely.

·        Keep current on all reimbursement terms/conditions, departmental procedures and applicable regulations.

o   Identify and report payer trends resulting in incorrect reimbursement

o   Identify and report internal system issues resulting in incorrect expected insurance reimbursement and or contractual adjustments.

o   Identify and report to internal departments issues/trends affecting reimbursement

·        Consistently meet productivity targets and quality assurance (QA) guidelines established by the Department.

·        Perform all other duties assigned, including but not limited to Correspondence / Mail / Customer Service Phone Forms

o   Follow up on all Insurance letters and phone calls, reopening accounts and forwarding to other departments as appropriate. 

o   Resolve disagreements with insurance companies and or their agencies.

o   Research returned checks for correct address and return to Supervisor within one week

o   Review the patient complaint phone form and respond within one working day for urgent requests and two working days for normal requests      

o   Perform any other duties assigned completely, accurately and timely

ACCOUNTS RECEIVABLE (A/R FOLLOW-UP)

·        Utilize Collector Workstation worklists/ADHOC/E-Query/Compass/ATB and IAR reports to identify accounts for follow up.

o   Follow up with third party payers within payer-specific timeframes to ensure timely and proper reimbursement via phone call, internet website, or payer system.

o   Promptly identify accounts needing initial or rebilling by using appropriate patient rep code.

o   Submit appeals to payers for reconsideration of denials or partial payments via payer website, INFO, letters, etc.

o   Maintain payer spreadsheets for internal, payer meeting, and payer project submission purposes timely and accurately.

o   Notify Lead or Supervisor of potential system or process issues needing further resolution in a timely manner.

o   Document all activity/action clearly and concisely in the Patient Accounting System.

·        Keep current on reimbursement terms/conditions, departmental procedures and applicable regulations.

o   Identify and report payer-specific trends resulting in incorrect reimbursement by monitoring rejections and underpayments in assigned AR.

o   Identify and report internal system issues resulting in incorrect reimbursement and/or contractual adjustments by monitoring all available reports.

o   Identify and report to internal departments issues/trends by monitoring accounts outstanding on shared communication reports with other departments.

·        Consistently meet productivity targets and quality assurance (QA) guidelines established by the Department.

·        Perform all other duties assigned, including but not limited to Correspondence / Mail / Customer Service Phone Forms

o   Follow up on all Insurance letters and phone calls, reopening accounts and forwarding to other departments as appropriate. 

o   Resolve disagreements with insurance companies and or their agencies.

o   Research returned checks for correct address and return to Supervisor within one week

o   Review the patient complaint phone form and respond within one working day for urgent requests and two working days for normal requests      

o   Perform any other duties assigned completely, accurately and timely

ACCOUNTS RECEIVABLE (CREDIT BALANCE REVIEW)

·        Review credit balance accounts via Collector Workstation worklists / ADHOC / E-Query / Compass / ATB and IAR reports and take action needed to resolve each account to zero in accordance with MLH guidelines.

o   Ensure that allowances are based on hospital- and payer-specific contractual agreements

o   Ensure that account reflects appropriate patient responsibility as per insurance EOB

o   Process allowance adjustments as appropriate, and report trends to Supervisor.

o   Notify Lead or Supervisor of potential system or process issues needing further resolution in a timely manner.

o   Document all activity/action clearly and concisely in the Patient Accounting System

·        Prepare Refund requests utilizing appropriate Excel form

o   Obtain copies of appropriate payments from Imaging. 

o   Check patient medical records for open accounts with patient balances, and for other accounts that can be refunded at the same time.

o   Provide accurate and concise documentation for refunds or adjustments

o   Follow all procedures as outlined in Refund Procedure

·        Correspondence/Mail/Customer Service Phone Forms

o   Follow up on all Insurance letters and phone calls, reopening accounts and forwarding to other departments as appropriate. 

o   Resolve disagreements with insurance companies and or their agencies.

o   Research returned checks for correct address and return to Supervisor within one week

o   Review the patient complaint phone form and respond within one working day for urgent requests and two working days for normal requests

·        Keep current on all reimbursement terms/conditions, departmental procedures and applicable regulations.  Via Collector Workstation worklists / ADHOC / E-Query / Compass / ATB and IAR reports:

o   Identify and report payer trends resulting in credit balances

o   Identify and report internal system issues resulting in credit balances

o   Identify and report issues/trends to internal departments

·        Consistently meet productivity targets and quality assurance (QA) guidelines established by the Department.

·        Perform all other additional duties as assigned.

Primary Customers or Key Working Relationships: Employees within Patient Accounting department, MLH employees outside department, third-party payers, patients.

Education:   High School Diploma or equivalent. 

Licensures & Certifications: 

New Employees:  As a condition of continued employment, successfully attain Certified Patient Accounting Technician (CPAT) certification from American Association of Healthcare Administrative Management (AAHAM) within 1 year of hire, and maintain recertification (every 3 years) within 6 months of expiration.

Existing Employees:  As a condition of continued employment, successfully attain Certified Patient Accounting Technician (CPAT) certification from American Association of Healthcare Administrative Management (AAHAM) within 1 year of revision date of job description, and maintain recertification (every 3 years) within 6 months of expiration.

Experience:   

·        One to two years billing experience and/or accounts receivable experience utilizing automated patient accounting systems preferred. 

·        Experience with Microsoft applications.

·        Knowledge of insurance contracts, regulations, and medical terminology preferred. 

·        Knowledge of HCPCS/CPT, ICD9, and revenue codes preferred. 

·        Good written/oral communications and problem solving skills required. 

·        Strong analytical, mathematical and organizational skills required.

*CB