This position is responsible for processing billings on behalf of the patient and appropriate third-party payers, as well as researching billing issues and following up on outstanding claims. Serves as a liaison between patients, coordinating agencies and/or other third-party payers. Should be knowledgeable of all State, Local and Federal financial assistance/eligibility programs available, to include Medicaid (all programs), Medicare, SSI (Supplemental Security Income), Non-Documented Alien Medicaid eligibility and the hospitals internal charity care requirements. Should be proficient in billing and collections using an automated system and electronic claims processing. This position may also assist in revenue cycle initiatives. This position requires the ability to work with minimal supervision.
- Reviews and processes inpatient and outpatient bills to patients and third-party payers on predetermined schedules.
- Serves as liaison with third-party payers/agencies regarding billion (billing)/optimal reimbursement and any other billing/payment issues or questions.
- Develops recommendations to maintain efficient and effective billing processes.
- Maintains insurance company master list.
- Serves as liaison to nursing, emergency room, patients, families and physician’s offices regarding insurance benefits.
- Processes all monetary transactions in an appropriate manner and reports daily to supervisor.
- Maintains accurate patient accounts including deductibles, co-payments, co-insurance, termination dates, effective dates, pending claims, etc.
- Performs data input of accurate insurance information, company and plan information to patient account when necessary.
- Is knowledgeable in reimbursement issues for Medicare, Medicaid, managed care and other third-party payers.
- Handles billing inquiries over the telephone and in person.
- Serves as liaison with third-party payers regarding benefit information and preauthorization procedures.
- Monitors rejected claims, coordinates the research for the filing of appeals and/or reviews with third-party payers.
- Processes past-due accounts with insurance balances, contacting third-party payers and/or patients as necessary to facilitate the timely payment of past-due charges.
- Ensure all placements and activity remains reconciled with all agencies (HRG/Complete Care/MSCB/MDS) for all entities.
- Ensure patient statements remain accurate and integrity of data is reconciled and any variances addressed in a timely manner.
- Review status updates on a regular basis, as directed (weekly and monthly), to identify variances between organizations.
- Monitors MedAssets Chargemaster system on a daily basis and coordinates updates from ancillary departments when needed.
- Keys daily updates in the HPF system to distribute payments and correspondence to the appropriate patient folders.
- Performs follow-up of payments plans as assigned by supervisor.
- Provides back up for admission/registration, and pre-certification benefits verification functions when necessary to ensure the functions are completed efficiently and timely.
- Maintains patient files.
- Maintains insurance logs as defined in policy.
- Serves as back-up for self-pay accounts and collection functions.
- Performs other duties as directed to provide the most efficient service to the hospital/clinic in a manner which supports the overall effectiveness of the department and the hospital/clinic.
- Education: High school diploma or equivalent required. Associate of Science preferred.
- Licensure/Certification: None required.
- Experience: Minimum of three years experience in medical insurance billing and/or claims processing/research required.