Job Details

Responsible for the accurate and timely processing of patient accounts related to billing, collections and reimbursements service for The Regional Medical Center in accordance with PFS standards, policies and procedures. Responsible for making the required number and acceptable quality of collection calls per day to obtain the required completion rate. Demonstrates a level of accountability to ensure data and codes are not changed on claims prior to submission. Gathers all information necessary to process patient claims. Ensures that daily productivity standards, billing and re-billing files are met to obtain the required completion rate.

What you will do

• Performs billing, collections and reimbursement services. * Ensures that all required financial/demographic information is secured. * Provides monitoring, follow-up, and research of all assigned patient accounts as required to maintain accurate records pertaining to patient and/or account information. * Provides courteous and professional customer service at all times.
• Reviews erroneous claims and researches Commercial guidelines to ensure corrections, adjustments, and proper modifications to claims in accordance with documented billing procedures. * Responds to patient and insurance company complaints, correspondence, inquiries and requests for information by analyzing charges and bill and contracted arrangements, determining billing errors. * Contacts clinical departments and HIM to obtain information to determine claim integrity and works with department to resolve claims. * Provides continuous updates and information to PFS management regarding ongoing errors, payer related issues, registration issues and other controllable related activities affecting reimbursement and payment methodology.
• Maintains an active working knowledge of all Governmental Mandated Regulations as it pertains to claims submission. * Ensures successful implementation of Governmental Regulatory Billing changes, including but not limited to Medicare OPPS effective August 1, 2000. * Performs the necessary research in order to determine proper governmental requirements prior to claims submission. * Collects balance owed from third party payers in accordance with state and federal laws governing collection practices. * Maintains an active working knowledge of all billing and reimbursement requirements by Payer. * Continuously receives updates and information regarding challenges and newly revised billing and reimbursement practices to ensure compliance.
• Ensures daily productivity standards are met and daily billing and re-bill files are cleared in accordance with documented procedure. * Biller - 120 accounts per day. * Collector - 45 accounts per day. * Validator - 80 accounts per day. * Ensures all correspondence, rejected claims and returned mail is worked within 48 hours of receipt during workdays. * Ensures daily EOBs, reports and appeal files are cleared within 48 hours of receipt during workdays. * Ensures business service requests are worked and documented within 24 hours of receipt during workdays. * Reviews and resolves claims that are suspended daily in electronic billing terminals in accordance with PFS procedure. * Works all discount applicable generated reports, providing proper documentation and making necessary corrections within 48 hours of receipt during workdays. * Ensures claims are submitted timely and no filing deadlines are received.
• Ensures quality standards are met and proper documentation regarding patient accounting records. * Identifies and forwards proper account denial information to the designated departmental liaison. * Dedicates efforts to ensure a proper denial resolution and timely turnaround. * Makes appropriate corrections to the BAR tables to ensure system calculated contractual adjustments are accurate. * Reviews all payments received to verify accuracy by evaluating the claim, account level charge information, contact and payment terms in accordance with Reimbursement Verification Procedure. * Ensures collection efforts are thorough and ethical to accomplish overall departmental objectives related to outstanding balances.
• Works collaboratively and cohesively with the team to assist in keeping workload evenly distributed. * Works with PFS Managers to assess the educational needs of associates and provides the necessary training and education on transactional processes. * Ensures consistent, open and honest communication with PFS Director and/or Managers regarding findings, recommendations and other financial opportunities. * Attends and participates in daily team briefings, metrics tracking and prompt resolution of Issues, Problems and Opportunities

• High School Diploma Or equivalent. Required
• Minimum 2 years experience Experience in facility reimbursement (hospital billing, insurance collection, hospital payment validation preferred) and reimbursement verification and/or refunds for government and/or commercial insurances. Required and
• College education, previous insurance company claims experience and/or health care billing experience may be considered in lieu of hospital experience. Required

Physical Demands

• Standing - Occasionally
• Walking - Occasionally
• Sitting - Constantly
• Lifting - Rarely
• Carrying - Rarely
• Pushing - Rarely
• Pulling - Rarely
• Climbing - Rarely
• Balancing - Rarely
• Stooping - Rarely
• Kneeling - Rarely
• Crouching - Rarely
• Crawling - Rarely
• Reaching - Rarely
• Handling - Occasionally
• Grasping - Occasionally
• Feeling - Rarely
• Talking - Constantly
• Hearing - Constantly
• Repetitive Motions - Frequently
• Eye/Hand/Foot Coordination - Frequently

Regional One Health is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.