Responsible for the duties and services that are of a support nature to the RCBS High Performance Work Teams. Ensures that all processes are performed in a timely and efficient manner. Performs assigned duties such as, cash posting, customer service, data entry and reviewing of claims for proper billing/collections. Responsible for performing billing, collections and reimbursement services of claims and duties to hospitals supported by the RCBS. In doing so, ensures that all claims billed and collected meets all government mandated procedures for Integrity and Compliance. Performs billing, collections and reimbursement services in a prompt and efficient manner. Provides thorough, courteous and professional assistance to patients, physician offices, insurance companies and other clients on an as needed basis while maintaining strictest confidence. Documents, forwards, resolves incoming mail and correspondence. Demonstrates a level of accountability to ensure data and codes are not changed on claims prior to submission if related to diagnosis, charge and/or other clinical type data that RCBS would not have knowledge of. Ensures all Compliance errors are reported to the Director and maintain records and files of documentation supporting bill changes that are directed by Director and/or Integrity Officer. Responsible to ensure successful implementation of Governmental Regulatory Billing changes, including but not limited to Medicare OPPS effective August 1, 2000.
Ensure daily productivity standards are met.
Maintains an active working knowledge of all Governmental Mandated Regulations as it pertains to claims submission. Responsible to perform the necessary research in order to determine proper governmental requirements prior to claims submission.
Responsible to contact Clinical departments and Medical Records in order to obtain information relevant to erred claims as possible Integrity issues. Works with Departments for proper resolution of erred claims. Maintains logs of Integrity related governmental claims and reports to Management weekly.
Reviews and resolves claims that are suspended daily in electronic billing terminals in accordance with procedure.
Responsible for working claims generated reports, providing proper documentation and making necessary corrections within specified times.
Ensures quality standards are met and proper documentation regarding patient accounting records
Reviews and resolves claims that are suspended daily in electronic billing files in accordance with procedure
Ensures all correspondence, rejected claims and returned mail is worked within 48 hours of receipt (allowing for weekends and holidays). Ensures business service requests are worked and documented within 24 hours of receipt.
Identifies and forwards proper account denial information to the designated departmental liaison. Dedicates efforts to ensure a proper denial resolution and timely turnaround.
Maintains an active working knowledge of all billing and reimbursement requirements by Payer. Continuously receives updates and information regarding changes and newly revised billing and reimbursement practices and ensures compliance
Provides continuous updates and information to Business Office Management regarding ongoing errors, payer related issues, registration issues and other controllable QA related activities affecting reimbursement and payment methodology.
Ensures all payments are retrieved and posted accurately and timely, post lockbox monies, EFT/ACH monies, credit card payments and patient payments.
Researches submitted cash payments by verifying patient account numbers and appropriate facility.
Keypunches all cash receipts and credit card payments and reconciles to batch.
Monitor and performs cash reconciliation to identify cash posting errors and ensures all receipts are applied and reconciles to daily bank deposit and monthly bank statements.
Review and post cash corrections, review and resolve unapplied cash.
Receives incoming calls to the department in a timely manner no later than third ring
Responds to patient and insurance company complaints, correspondence, inquiries and requests for information by analyzing billing errors and makes appropriate corrections.
Collects balance owing from third party payers in accordance with state and federal laws governing collection practices. Ensures that collection efforts are thorough with overall objectives being to collect outstanding balance in an ethical manner.
Responds to patient and insurance company complaints, correspondence, inquiries and requests for information by analyzing charges, bill and contracted arrangements and makes appropriate corrections.
Complete Attorney requests for billing records and subpoenas
Key all refunds requested by PFS and create corresponding insurance letters
Work credit balance queues in CollectLogix.
Prepare graphs by region to be used as a credit balance tracking tool
Process patient refunds at request of vendors and/or regional facilities
Perform weekly check run by region
Work outstanding check logs
Work unclaimed property reports, key voids/stop payments
Monitor and communicate errors generated by other groups and evaluate for trends
Demonstrate the ability to read and understand client contracts
Perform billing/collections/validations tasks as it relates to specific payer contracts
Perform billing tasks received via spreadsheet
Post payments to client accounts
Submit spreadsheet and client billing as scheduled with client's contract.
HS Diploma or equivalency required
Post HS education preferred
Must have minimum of 2 years' experience in a Customer Service call enter environment with a focus on healthcare or insurance billing or 2 years' experience with commercial insurance billing, collections, payment and reimbursement verification and/or refunds.
Understanding of alternative Business Office financial resources and the ability to provide information and/or recommendations related to these sources of recovery are preferred.
General hospital A/R accounts knowledge is required.
College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.