Ensure prompt and efficient handling and filing of insurance claims and related documents in order to receive payment in a timely manner. This is accomplished by following up with insurance companies (government and non-government) as well as identifying and resolving problems. In performance of these duties, this role is responsible for and includes, but is not limited to the following:
- Average quantity and value of accounts worked each day meets standards. Working an account includes for filing, re-billing, appealing and working of insurance claims on the hospital accounts receivables.
- Updates to patient accounts notes in the financial software system are documented with appropriate detail.
- Adjustment request are accurately computed and documented.
- Patient account’s tools are being utilized to enhance and expedite collections.
Work files used with appropriate work-again dates, action codes, sorts, etc.
Carrier web sites are being utilized, as well as Medicare DDE and Novisphere.
- Patient account notes reflect the aggressive collection logic necessary for expediting payments.
- Responsible for processing all assigned bill error claims on a daily basis.
- Responsible for processing assigned bill hold claims on a daily basis. Ensures that the hold claims are at an acceptable level. Communicates with the appropriate departments to ensure data is obtained timely in order to file the claim.
- Ensures there is no excessive and/or unjustified amount of backlogged claims in the work area. Maintains a clear understanding of goals set and strives to meet these goals weekly.
- Able to perform manual intervention of claims such as “split bill”, add charges, or any other procedure necessary to process an account.
- Responsible for filing all assigned claims requiring special documentation. Each claim must be reviewed, mail on a daily basis.
Must be able to demonstrate knowledge and skills to appropriately communicate and interact with the patients, families, and visitors of all age groups while being sensitive to their cultural and religious beliefs.
- Ensure Primary claims available for billing are completed in EPIC and available for SSI transmission daily.
- Work and resolve all claim edits daily.
- Notates accounts in EPIC fully on each account worked daily. If it isn’t noted, it wasn’t done.
- Maintain follow-up and denial work queus at a level that ensures no accounts are unworked for 15 business days after presenting to the work queue.
- Informs Manager of claim edit issues within 24 hours of identifying the problem.
- Achieve Collection Goals set each month.
High school diploma or equivalent required. Medical Billing and Coding Degree preferred.
A minimum of 2-3 years is required in insurancebilling and/or follow-upexperience in a physician office, other outpatient or hospital setting.Experience operating personal computer and calculator accurately is required. Experience with Microsoft Excel required. Six month probationary on the job training is required to become familiar with Forrest General Hospital’s policies and procedures.
Numerical ability is required to calculate and check insurance billings. Verbal ability is required to interpret and explain Medicare/Medicaid/Managed Care/Commercial Insurance payment policies and procedures. Must have the ability to communicate effectively.