BillingCollector - Full-Time - AVALA Hospital RH263

Summary

Responsible forthe collection processes on accounts related to all Medicare Medicare A Medicaidand other state and federal health care programs in order to expedite claimprocessing and reimbursement. Reviews denialsand submits appeals following Medical LCDs and NCDs guidelines. Assist withsupport in other areas as needed.

Essential Duties and Responsibilities

• Performsfollow ups on outstanding accounts and provides companies with any informationthat will allow them to expedite payment and processing of the claim. Documents all efforts into computer software.
• Consistentlyidentifies and resolves billing discrepancies to ensure and expeditereimbursement; works closely with billing and keeps team appraised of issuesand problems with billing processes and companies; works all denials and filesappeals when necessary to protect reimbursement. Follows up until resolved.
• Worksall insurance denials from assigned payers; document all denials and notifiesBusiness Office Manager in a timely manner.
• Processpatient and insurance refunds and attaches a copy explanation of benefits forreference.
• Reviewaccounts and forwards qualified accounts to collections if needed.
• Assistcollection agency with questions on placed accounts.
• Reviewspatient statement listing each week to identify any accounts that require astatement hold and places hold when appropriate.
• Coordinatesany accounts requiring a rebill with the biller.
• Answerpatient inquires in a timely manner.
• Keepsupdated on all contract terms and CMS regulations.
• Assistwith billing questions as needed.

Core Competencies

ActionOrientation Targets and achieves results overcomes obstacles acceptsresponsibility establishes standards and responsibilities creates aresultsoriented environment and follows through on actions.

Communications Communicates well both verbally and in writing. Effectively conveys andshares information and ideas with others. Listens carefully and understandsvarious viewpoints. Presents ideas clearly and concisely and understandsrelevant detail in presented information.

Creativity/Innovation Generates novel ideas and develops or improves existing and new systems thatchallenge the status quo takes risks and encourages innovation.

CriticalJudgment Possesses the ability to define issues and focus on achievingworkable solutions. Consistently does the right thing by performing withreliability.

CustomerOrientation Listens to customers builds customer confidence increasescustomer satisfaction ensures commitments are met sets appropriate customerexpectations and responds to customer needs.

InterpersonalSkills Effectively and productively engages with others and establishestrust credibility and confidence with others.

Leadership Motivates empowers inspires collaborates with and encourages others.Builds consensus when appropriate. Focuses team members on common goals.

Teamwork Knows when and how to attract develop reward and utilize teams to optimizeresults. Acts to build trust inspire enthusiasm encourage others and helpresolve conflicts and develop consensus in creating highperformance teams.

Professional Requirements

• Meets dress code standards and adheres topolicy.
• Completes annual education requirements.
• Maintains regulatory requirements.
• Maintains patient confidentiality at all times.
• Reports to work on time and as scheduledcompletes work within designated time.
• Wears identification while on duty usescomputerized punch time system correctly.
• Completes inservices and returns in a timelyfashion.
• Attends annual review and departmentinservices as scheduled.
• Attends staff meetings annually reads andreturns all monthly staff meeting minutes.
• Represents the organization in a positive andprofessional manner.
• Actively participates in performance improvementand continuous quality improvement (CQI) activities.
• Complies with all organizational policiesregarding ethical business practices.
• Communicates the mission ethics and goals ofthe hospital as well as the focus statement of the department.
• Assists other staff members in performing anyduty that enhances the delivery of patient care.

Regulatory Requirements

• High school diploma.
• Two years or more experience.

Skills

• Ability to communicate effectively in Englishboth verbally and in writing.
• Basiccomputer knowledge.

Physical Demands

The physicaldemands described here are representative of those that must be met by anemployee to successfully perform the essential functions of this job. Whileperforming the duties of this job the employee is regularly required to talkand hear. This position is very active and requires repetitive motionsstanding walking bending kneeling and stooping all day. The employee mustfrequently lift or move items weighing up to 20 pounds.