Responsible for financial resolution of receivables by verifying appropriate reimbursement for services rendered. Achieved by persuasive collection techniques, resolving eligibility, billing, or other related obstacles, according to the existing procedures for collection and by utilizing all available patient accounting and payor software.
1. Works daily with automated worklist in patient accounting system to perform account audits of insurance and patient payments. Utilizes claims editing software and/or payor software to review claims history in order to address and resolve payment delays and/or incorrect payments.
2. Maintains ability to read and comprehend all payors’ claims adjudication vouchers, explanation of benefits (EOB), or electronic remittance advice (ERA). Utilizes vouchers, EOB, and ERA to help confirm proper processing of claims and appropriate levels of reimbursement.
3. Maintains a current and thorough knowledge of regulatory and procedural requirements related to the assigned account workload. Knowledge of applicable contracted payor documents including the contract matrix and state and federal regulations are required. Regulations include but are not limited to various reimbursement methodologies depending on the services billed and claims editing content.
4. Contacts insurance companies or clients and uses proper negotiation or persuasion techniques to elicit payment promise or account resolution. When necessary, works with billers to perform re-bills or secondary billing. Calendars follow up collection calls and activities, according to existing procedures in order to meet personal productivity and departmental receivable goals.
5. Performs appeals of insurance denials and/or incorrect reimbursement. Facilitates medical record documentation submissions when medical necessity is the basis for denial and other required documentation when expected reimbursement is not received.
6. Responds timely (within 24 hours or next business day) to account inquiry calls from patient or insurance company. Research claim or account questions with responsible department and provide customer with requested financial information or refer them to other resources in the National Jewish Health (NJH).
7. Processes all refunds, payment transfers and adjustments for account workload according to established Patient Financial Services (PFS) policy.
8. Contacts patients when necessary to elicit claim and account resolution.
9. Identifies self-pay accounts and potential bad debt accounts for referral to outside agency or attorney for further collection efforts.
10. Communicates regularly with Supervisor or Manager regarding high-risk accounts.
11. Provides Supervisor and reports weekly productivity statistics and report workload fluctuations (backlog or shortages) in a timely manner.
12. Assures awareness of age difference among the National Jewish patient population and has the ability to interact with them.
13. Actively participate in team and departmental meetings by sharing ideas for improved work processes in PFS.
14. Performs as a back-up to staff absences and vacancies, as necessary.
15. Performs all other duties as assigned.
1. Performs, as directed, safety compliance and uses Personal Protective Equipment (PPE), as needed.
2. Participates in Quality Assessment (QA) and Quality Improvement (QI) programs, as directed.
3. Ensures compliance with The Joint Commission and all other Federal, State and Regulatory Agencies.
4. Responds promptly and sincerely to customer’s needs, requests and concerns via all communication forms using easily understood language and refraining from using inappropriate language and non-verbal gestures.
5. Maintains positive working relationships as a team player through problem solving issues, speaking positively about others, listening attentively and observing the Patient Bill of Rights and Confidentiality.
6. Increases customer service knowledge, skill and ability by participating in department and institution-wide specific programs.
7. Incorporates National Jewish’s identity (Science Transforming Life®) into daily functions. Speaks positively about the institution, provides customers with prompt service, maintains a clean and safe working environment, dresses appropriately based upon National Jewish safety standards, and departmental policies and wears an ID badge visibly.
Knowledge and Skills
Complex mathematical proficiency. Effective and diplomatic oral and written communication skills including successful negotiation techniques and problem solving with difficult customers. Ability to problem solve, organize and prioritize work in an environment with frequent interruptions. Computer experience must include using PCs and common patient accounting software systems. Familiar with medical terminology, HIPAA, NCCI, UB & 1500 claims, 837i and 837p electronic claims, ICD-9, ICD-10, HCPCS and CPT coding.
High school graduate or equivalent preferred. Some college level course work, preferred.
Certification and Licensure
A minimum of two (2) years in hospital billing/collection, business administration, accounting or customer service environment is required. A minimum of one (1) year of recent and related healthcare collection or billing experience is preferred.
- or - Any equivalent combination of Education and/or Experience
Position is an office environment. Frequent requirements may include: sitting for extended periods, entering and manipulating data on a workstation computer and participating in team/executive meetings. Approximately 75% of daily responsibilities will be working both one-on-one and in teams with other personnel and extended one-on-one contact in a quiet environment where hearing and listening is paramount. Must possess the ability to communicate by observation, verbal, written and listening; standing; walking; climbing stairs; stooping to remove/replace files; good hand-eye coordination; lifting, pulling, pushing, and upper body twisting while handling supplies and equipment; sitting while completing paperwork; using keyboard for PC and word processing needs. Occasional requirements may include: stand, walk, use hands to manipulate, handle or feel objects, tools, or controls, reach with hands and arms, stoop, kneel, and lift/move up to 25 pounds. Incumbent may be scheduled to work an alternate schedule to accommodate essential business needs routine travel by foot or automobile to alternate work/meeting locations, possibly during inclement weather.
No environmental conditions indicated. Professional office environment with time of each day spent in interaction with management/staff, in addition to planning and working autonomously. Requires teamwork and the ability to handle multiple interruptions; frequently fast-paced; high-pressure; occasionally variable-paced; variable pressure. Personal Protective Equipment (PPE) will be provided to each employee when needed as determined by policy. Utilization of PPE is mandatory. Estimated 1500 employees in the worksite.