Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.

PRIMARY PURPOSE

 

Reviews claims to resolve outstanding balances and secure accurate and timely payments from third party payors.

 

MINIMUM SPECIFICATIONS

 

Education

- Must have a High School diploma or GED.

 

Experience

- Must have three (3) years of experience in a hospital business office, physician business office, or insurance company, to include two (2) years of experience in medical billing and/or collecting from third-party payors

 

Equivalent Education and/or Experience

- May have an equivalent combination of education and/or experience in lieu of specific experience as stated above.

 

Certification/Registration/Licensure

- None

 

Skills or Special Abilities

- Must be able to demonstrate a working knowledge of personal computers and other standard office equipment.

- Must be able to exercise good judgment in handling government and/or non-government accounts and understand managed care and insurance contractual arrangements.

- Must have working knowledge of medical software.

- Must be detail oriented, possess basic mathematical skills, and have sharp analytical skills to resolve financial issues as they relate to multiple groups including third party payors, physicians, patients and the system.

- Must demonstrate a positive demeanor, good verbal and written communication skills, and be professional in both appearance and approach.

- Must be able to handle potentially stressful situations and multiple tasks simultaneously including discussing outstanding claims with the insurance company, taking action on denied claims, and processing appeals.

- Must be able to communicate effectively with patients, families, government entities, insurance companies, and Parkland staff.

- Must be able to solve problems within the guidelines of established policies and procedures.

- Basic medical terminology knowledge preferred.

- Bilingual skills preferred.

 

Responsibilities

1. Contacts payors to follow-up on outstanding claims for assigned accounts to verify reason for non-payment and corrects account, re-bills claim, and/or performs adjustments.

2. Responds to routine denials from payors such as inability to identify the patient, coordination of benefits, non-covered services, past filing deadlines to ensure information is transmitted that is required to process payments. Performs required actions in order to resolve the account balance promptly by submitting appeals, correcting account information, coordinating requests for medical records, and posting account adjustments.

3. Documents all actions taken on accounts in the system account notes to ensure all prior actions are noted and understandable by others.

4. Performs routine audits of individual accounts to resolve all discrepancies in account balances.

5. Informs the Supervisor of any problems or changes in payor requirements and exercises independent judgment to analyze and report repetitive denials so that corrective actions can be taken.

6. Tracks productivity and provides cumulative reports on a daily, weekly or monthly basis, as required by supervisor and/or manager.

7. Maintains a positive working relationship with contacts at all agencies, patients, insurance companies, government entities, clinical personnel, other Parkland staff and management, to promote teamwork, cooperation, and a positive public image for Parkland. Serves as a positive role model for staff and patients and demonstrates strong interpersonal skills. Accepts constructive criticism and integrates suggestions in effective ways

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status. As part of our commitment to our patients and employees’ wellness, Parkland Health is a tobacco and smoke-free campus.