In 2020, united in a fierce commitment to deliver the highest quality care and exceptional patient experience, Virginia Mason and CHI Franciscan Health came together as natural partners to build a new health system centered around the patient: Virginia Mason Franciscan Health. Our combined system builds upon the scale and expertise of our nearly 300 sites of care, including 11 hospitals and nearly 5,000 physicians and providers. Together, we are empowered to make an even greater impact on the health and well-being of our communities.
CHI Franciscan and Virginia Mason are now united to build the future of patient-centered care across the Pacific Northwest. That means a seamlessly connected system offering quality care close to home. From basic health needs to the most complex, highly specialized care, our patients can count on us to meet their needs with convenient access to the region’s most prestigious experts and innovative treatments and technologies.

This job is responsible for both charge review and cash posting functions for the Franciscan Medical Group (FMG), including the review of patient encounters and corrections in accordance with applicable guidelines. An incumbent will execute various charge review tasks to validate that charges are entered, edited and billed in a timely and efficient manner in order to maximize revenues, and serve as a resource to other staff/departments for complex charge review/entry issues.
Work also includes entering patient and insurance payments, contractual allowances and other adjustments onto the patient’s account and interpretation of Explanations of Benefits (EOBs)/Electronic Remittance Advice (ERAs) from insurance.
Work requires an understanding of detailed billing requirements, charge review/cash posting processes and government/commercial insurance reimbursement terms, remittance advice details and contractual/other adjustments. Attention to detail, the ability to accurately and timely troubleshoot/resolve (within position scope) issues that have a potential impact on revenues are also required.

Essential Job Functions

Reviews and re-enters corrected encounter data and other clinic-generated source information in accordance with applicable guidelines and quality/production standards for paper-based charges.
Reviews encounters that are in charge review work queues and make corrections as appropriate and in accordance with applicable guidelines for electronically-transmitted charges.
Reviews all patient account charges and enters timely corrections to prevent billing delays.
Conducts appropriate reviews using critical thinking skills to understand how to transfer payments.
Reviews and posts payments and write-off/adjustments from insurance and patients.
Reviews Explanation of Benefits (EOBs)/ Electronic Remittance Advice (ERAs), payments, adjustments, insurance contracts and contracting system, insurance benefits, and all account comments; applies knowledge of payer contracts and experience with insurance reviews to gather additional information as necessary.
Posts and tracks electronic funds transfer (EFT) information and validates EFTs for accuracy.
Follows write-off approval protocols for non-routine adjustments.
Completes daily posting log and quarterly cash handling audits and reports findings to Supervisor.
Identifies and researches unusual, complex or escalated issues as assigned; applies problem-solving and critical thinking skills as necessary to resolve issues within the scope of position authority or to escalate following established procedures.
Notifies Supervisor/Manager of ongoing issues and concerns as appropriate.
Documents all activities and findings in accordance with established policies and procedures; ensures the integrity of all account documentation; maintains confidentiality of medical records.
Meets quality assurance and productivity standards for timely and accurate posting of charges/payments in accordance with organizational policies and procedures.

Maintains current knowledge of internal, industry, and government regulations as applicable to assigned function.
Has knowledge of, and is compliant with, government regulations including "signature on file" requirements, compliance program, HIPAA, etc.
Applies current knowledge of detailed billing requirements and charge capture/cash posting processes.
Applies current knowledge of government/commercial insurance reimbursement terms, contractual and/or other adjustments and remittance advice details.
Establishes and maintains professional and effective relationships with peers and other stakeholders.
Establishes and maintains a professional relationship with clinics and FMG staff in order to resolve issues.
Depending on role and Epic training, may be called upon to support other areas in the Revenue Cycle.
Performs related duties as required.

Education/Work Experience Requirements
Two years of revenue cycle or related work experience that demonstrates attainment of the requisite job knowledge and abilities; OR
Post-high school education in a field (e.g. medical billing) that would demonstrate attainment of the requisite job knowledge/abilities may be substituted, on a month-for-month basis, for one year of the experience requirement.
Job Knowledge/Abilities:
Knowledge of general concepts and practices that relate to the healthcare field, and specific policies, standards, procedures and practices that pertain to the assigned function.
Knowledge of debits and credits, including how to interpret/process electronic remittance advices.
Knowledge of clinic operations related to patient registration, referrals and cash collections.
Knowledge of general office principles, practices, standards, systems and tools/equipment.
Knowledge of medical insurance, payer contract, CPT and ICD codes.
Knowledge of the regulatory/reporting requirements that pertain to the assigned function.
Knowledge of sources and availability of information relevant to the assigned function.
Knowledge of the operation and application of automated systems applicable to the assigned function.
Ability to understand and apply detailed billing requirements and charge capture/cash posting processes.
Ability to understand and apply government/commercial insurance reimbursement terms, contractual and/or other adjustments and remittance advice details.
Ability to enter data in accordance with established standards of timeliness, accuracy and productivity.
Ability to keep abreast of trends, developments and changing regulatory requirements that impact matters within designated scope of responsibility.
Ability to identify and articulate non-compliance with established guidelines and/or regulatory requirements.
Ability to troubleshoot, understand and/or adapt moderately complex oral and or written instructions/guidelines to diverse or dissimilar situations.
Ability to maintain confidentiality of medical records, and to use discretion with confidential data and sensitive information.
Ability to demonstrate attention to detail and critical thinking skills within the context of the assigned function, with a commitment to accuracy.
Ability to effectively prioritize and execute tasks while under pressure.
Ability to make decisions based on available information and within the scope of authority of the position.
Ability to demonstrate excellent customer service skills, including professional telephone interactions.
Ability to read, understand and communicate in English sufficient to perform the duties of the position.
Ability to establish and maintain effective working relationships as required by the duties of the position.
Ability to use office equipment and automated systems/applications/software at an acceptable level of proficiency.