Accounts Receivable RepresentativeCoder II

SECTION I

BASIC FUNCTION:

The Accounts Receivable Representative/ Coder will be responsible for achieving accurate and timely accounting for professional accounts receivable as set by policies and procedures. Responsible for reviewing and posting charges payments and adjustments to the patient accounting system on a daily basis and ensuring outgoing data is accurate. Review and resolve outstanding accounts receivable with insurance companies and addition to AR responsibilities this position will be responsible for coding review resolving coding edits and denials with the focus on ensuring that the account is resolved in a timely and appropriate manner.

SECTION II

EDUCATION AND EXPERIENCE REQUIREMENTS:

Education: High School Diploma or Equivalent required. Associates degree preferred.

Certification in professional medical coding required.

Experience: 5 years of accounts receivable and/or coding experience a hospital/ physicians office or healthcare setting.

Must have knowledge of medical records medical terminology and billing requirements CPT HCPCS and ICD-9 coding and be able to apply such coding to a descriptive procedure and / or diagnosis.

Windows-based software required including but not limited to Microsoft Windows Excel and Word. Experience Soarian and Cerner billing and EMR systems preferred.

SECTION III Physical Requirements

Should be able to push/pull lift/move 15 lb. be able to perform moderately difficult manual manipulations such as using a keyboard writing and filing for extended periods of time must be able to perform tasks which require hand-eye coordination such as data entry typing and using photo copiers. Mobility requirements may include the ability to be stationary at a workstation for a prolonged period of time in addition to being able to squat or be mobile for a reasonable length of time and distance. Communication requirements include the ability to comprehend the spoken English language in addition to being able to communicate and read the English language.

SECTION IV

RESPONSIBILITIES OF THE POSITION:

Responsible for achieving accurate and timely accounting of professional accounts receivable as set by policies and procedures.

Responsible for reviewing payments and adjustments to the patient accounting system daily and ensuring outgoing data is accurate.

Review and resolve outstanding accounts receivable with insurance companies and patients.

Claims in dispute with payers are reviewed daily to ensure the provider and payers agree for appropriate claims reimbursed.

Monthly meetings with all payers to continuously improve communication between provider and payer to resolve issues reduce outstanding aged accounts increase cash flow and receive any updates on insurance regulations.

Handles and processes all customer calls and written requests in Patient Financial Services (PFS) and responds in a timely manner to challenging customers patients insurance companies other healthcare providers physicians and adverse situations in a professional and courteous manner.

Aids and information on programs to assist patient and family financial issues (i.e. Medicaid Program Uncompensated Care).

Facilitates in gathering accurate patient billing information.

Performs collections of patients with outstanding accounts receivable. Accurately estimates the patient liability (copayments deductibles coinsurances deposits etc. via obtaining accurate demographic and financial information.

Receives and processes patient payments. Maintains necessary petty cash to properly service and receive payments.

Answers patient inquired regarding their liability and being able to explain the variables involved.

Properly receipting and forwarding all copies of patient payment receipts posting to the patients account in Sorian Financials.

Perform end of day dutites closing and reconciliation duties in Sorian Financials and reconcile deposit slips.

Review Billing Exception Report for Revenue Management the Medicare system (FISS) and the claims scrubber (SSI) daily for data entry errors and make corrections. Notify the supervisor when a system error occurs. Log and forward to the source for correction if there is a registration error or missing claim form.

Once all errors have been identified and corrected each claim will be reviewed to verify is attachments are required for submission (i.e. Primary carrier payments Medical Records Workers Compensation C-4 or No Fault forms) then claims will be submitted daily to the appropriate payer as indicated.

Analyze 277 Rejection Remittance Reports to verify all payor denials including eligibility denials and edit denials.

Calculate the usual and customary rate for any deductibles coinsurance and / or adjustments according to the Professional and Technical reimbursement and contracts procedures and policies.

Assist the cash posting staff with any questions in regards to payor remittances to ensure timely cash posting. Ensure appropriate Financial System transaction codes are applied to payments and allowances.

Unidentified cash will be researched with the payer for correct posting or be refunded to the payer within 30 days.

Each denial will be reviewed for appropriateness and will be either corrected or billed to the next responsible party.

Follow up on aging accounts with each payer within 15 to 45 days from insurance / guarantor bill date. Each account must show some activity that explains its age (i.e. Online Comment from follow-up payment arrangements etc.).

Proper correspondence to insurance companies and guarantors must be made to obtain payment status or make arrangements.

All guarantor phone calls for the purpose of debt collection will be held to Customer Service standards.

Accomplish the days tasks as set forth by the position policies and procedures.

Complete required training as assigned.

Responds promptly to customer requests provide excellent customer service and collaborates with other departments throughout the organization.

Adhere to patient privacy policies and procedures maintain confidentiality.

Additional duties as assigned.

SECTION V

Ellis Medicine is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race creed color religion sex/gender age national origin disability genetic information predisposition or carrier status military or veteran status prior arrest or conviction record marital or familial status sexual orientation transgender status gender identity gender expression reproductive health decisions or domestic violence victim status.

Salary Range: $18.33-26.58/hourPay is based on experience skills and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.