Managed Care Follow Up Rep Patient Account Rep

OHSU is Oregons only public academic health center. We are a system of hospitals and clinics across Oregon and southwest Washington. We are an institution of higher learning with schools of medicine nursing pharmacy dentistry and public health and with a network of campuses and partners throughout Oregon. We are a national research hub with thousands of scientists developing lifesaving therapies and deeper understanding. We are a statewide economic engine and Portlands largest employer. And as a public organization we provide services for the most vulnerable Oregonians and outreach to improve health in communities across the state.

To bill process adjustments collect on accounts and/or perform customer service duties to ensure that monies due University Hospital are secured and paid in a timely manner and the AR outstanding days of revenue are kept to a minimum. Assignment will be flexible depending on payor mix patient flow and workload

fluctuations.

Third party followup and collection:

• Within the stratified processing environment collect assertively and proactively money due OHSU by contacting (through telephoningemailing and/or accessing online systems) third parties (insurancecarrier various government programs etc.
• Provide explanation of charges and additional requested information to the third parties.
• Analyze accounts to determine coordination of benefits refunds and denials to insure appropriate resolution of accounts.
• Review billing to determine medical records necessary to provide complete processing of claim.
• Analyze accounts with regard to billing and payment history and uses judgment to determines appropriate followup action based on departmental guidelines
• Contact patient/guarantor to resolve issues (includes tracing and locating patient/guarantor by telephoning and/or sending written correspondence.
• Analyze accounts and interpreting contracts that dictate how claims should be paid and processing adjustments for contract interpretation.
• Comply with special billing and followup requirements regarding adoptions court holds motor vehicle and personal injury accidents and other unique or sensitive accounts

Billing

• Submit bills that comply with all appropriate regulations managed care contracts to third party payors.
• Calculate the correct reimbursement of all managed care claims.

Other duties as assigned within the scope of the established class specs. Toalso include activities that are classified as team support and environmentalactivities

• Two years of recent (within the last 5 years) experience billing or collecting healthcare accounts in a business office;OR
• Four years of general collection billing or customer service experience; OR
• Equivalent combination of education and experience.
• Certified Revenue Cycle Specialist (CRCS) is required within 18 months of hire.

• Experience in billing Hospital claims or UB04 claims.
• Recent (within one year of date of hire) Microsoft Office Suite experience in Windows environment with skill in document production using WORD spreadsheet construction in EXCEL.
• Knowledge of and experience in interpreting managed care contracts.
• Familiarity with DRG CPT HCPC and ICD9 coding
• Typing 45 wpm
• Demonstrated ability to communicate effectively verbally or in writing.
• Demonstrated ability to prioritize and accomplish multiple tasks in a fast paced environment; consistently adhering to defined due dates.