Denial Management Rep (Patient Account Rep)

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.

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.

Third party followup and collection:

• Within the stratified processing environment collect assertively and proactively money due OHSU by contacting (through telephoning emailing and/or accessing online systems) third parties (insurance carrier 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.
• Work reports of denied claims to trend and report these claims to the department and to our front end partners.
• Work closely with admitting care management and ambulatory services on the denied claims for resolution and feedback purposes.
• Prepare the appeals for selected denials.

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

Standards:

• Complete all work with extreme accuracy complying with quality standards of unit
• Handle a high volume of work in an efficient timely manner complying with unit standards
• Work well in a team environment
• Maintain a positive attitude
• Be punctual and maintain good attendance

• 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 or billing experience OR

• Equivalent combination of education and experience.

• Certified Revenue Cycle Specialist (CRCS) is required within 18 months of hire.
• Perform all duties in a manner which demonstrates the ability to work in a collaborative selfmanaged and self directed workteam environment.

• 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.

• Experience in billing Hospital claims or UB04 claims.

• Knowledge of and experience in interpreting managed care contracts.

• Familiarity with DRG CPT HCPC and ICD10 coding

• Typing 45 wpm

• Ability to use multiple system applications

• 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.