Job Summary/Objective:
Analyze reimbursement methodologies; ensure compliance issues are adhered to in accordance with State and Federal regulations. Bill and collect receivables for patient care services, identify processes, write offs, and constant cash flow, and support the financial viability of the organization

Essential Job Functions

Reviews payment/ account status and contacts responsible parties by phone/ correspondence to arrange payment for services according to department standards and collects payment due from payers in order to ensure financial reimbursement for services rendered and supports employee’s questions.

• Reviews the account to identify facility/satellite offices that rendered service and that is responsible for account payment and account status: i.e. non-insured, co-insured, and 3^rd party payment, according to department standards.
• Obtains financial information from responsible party/person and updates in the appropriate application to ensure that the patient responsibility portion can be billed accurately and timely.
• Identifies, researches, and determines accurate coordination of benefits (COB) for new sources of payment. Updates and communicates changes in system and to the appropriate parties.
• Contacts Third Party payers to determine account status and expected date of payment. Research/reviews payments variance with payer and brings account to resolution.
• Demonstrates the ability to make sound decisions to produce the maximum collection effort possible based upon various collection scenarios and escalates to management problematic collection accounts.
• Demonstrates proficiency and understanding of the accounts receivable revenue cycle and utilizes payer specific computer websites/resources to maximize collection efficiency.

Maintains patient accounts to support accurate net-accounts receivable in accordance with policy and demonstrates the ability to effectively and efficiently document an account to maximize collection efforts and provide a positive impact on the accounts receivable.

• Analyzes accounts to determine if payment received has met the contractual agreement with payer and/or responsible party.
• Performs the appropriate adjustments, allowances or write-offs based on contract, policy and agreements using the correct service codes.
• Reconciles individual accounts and analyzes payments to ensure that they are accurately reflected and communicates with cash control and supervisor any suspicious variances.
• Enters demographic and financial changes, comments and adjustments in the appropriate application within the designated field and performs rebills and updates corresponding accounts, as needed.
• Demonstrates the ability to understand system application ability/inability to perform certain allowances and to manually perform these allowances to ensure account integrity.
• Provides detailed information in the appropriate database for any collection effort, correspondence/phone call received on behalf of the organization. Detailed information will include, but not limited to insurance company name, phone number called, contact name and nature of call.
• Timely documents accounts and completes proofing encounters for accuracy, to include coverage, CPT, ICD-9, signatures, and coverage limitations of the payer source for the patient.

Required Education and Experience

• High School graduate or equivalent.
• Two years of related experience preferred.

AAP/EEO Statement
In order to provide equal employment and advancement opportunities to all individuals, employment decisions will be based on qualifications and job related abilities. We do not discriminate in employment opportunities or practices on the basis of race, color, religion, sex, national origin, age, disability, ancestry, sexual orientation, marital status, gender identity or any other characteristic protected by law. We will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in undue hardship.

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