Reviews and analyzes documentation for billing, collections and Medicaid application and re-certification. Updates/monitors/maintains all tracking systems necessary for timely submission of documentation and collections of accounts receivable. Identifies issues/trends regarding collection and payments, makes recommendation based on findings and initiates/follows up with the resolution to ensure timely collection and adherence to departmental, Agency, and external policies/guidelines. Works under general supervision.
Responsibilities
Reviews weekly accounts receivables report, identifies/determines accounts requiring collection, anticipates/obtains required supporting documentation and contacts/re-bills/follows-up with third party payers to obtain reimbursement in a timely matter. Records/inputs all collection activity for each patient account into system to ensure up-to-date and accurate record keeping of actions taken to secure payment.Receives/reviews denial notifications, and determines appropriate action, including advising/requesting/obtaining documentation from regions to reverse denial. Inputs/tracks/updates denials in departmental database to ensure up to date and accurate record keeping of actions taken to secure payment. Notifies and collaborates with supervisor on significant/irresolvable problems and initiates alternative approaches, as needed, to resolve issue.Identifies general and specific payer issues/trends regarding collection/payment activities, analyzes findings, recommends/implements resolution or new initiatives. Compiles/analyzes/prepares weekly/monthly/ ad-hoc reports identify trends/issues related to payers, collection activity, productivity, etc, and presents findings/recommendation to management as needed.Issues follow-up correspondence/calls to payers to request status on any unresolved denials. Collaborates/negotiates with payers to resolves denials and partial payments in a timely manner. Provides collection activity documentation for irresolvable cases and makes recommendation to Supervisor for write-off after all means of collection have failed and forwards to the Supervisor /Manager of Patient Accounts for review/action.Assists with verification, validation and prioritization of payer setup for patients. Ensures payers are set up properly to maximize reimbursement. Implements processes to minimize verification-related delays. Assists with reimbursement processing through identification and set-up of payment sources for patients/services with unbillable charges.Requests, obtains and enters managed care authorizations for patients. Implements initiatives to minimize authorization related delays to patient care while maximizing collections. Keeps abreast of standards related to commercial credit and collections by attending internal and external seminars, meetings, and training programs.Determines/reviews required documentation needed from patient in order to initiate and process applications and re-certification. Contacts and follows-up with patient/designee to ensure receipt of application, explains process and defines acceptable documents necessary for application submission in a timely manner and submits to Human Resources Administration (HRA) office for eligibility/recertification processing.Assists supervisor /manager in processing of COB, Write-off’s, and billing secondary payers vouchers. Develops and maintains a strong customer service focus in dealing with internal/external customers (e.g., responsiveness to customer needs, manners with customers, listening to customer, etc.) to ensure an ongoing supportive relationship, and to convey a positive image of department and Agency.Participates in special projects and performs other duties, as required.
Qualifications
Education: Bachelor's degree or equivalent in Business, Accounting or related discipline preferred.
Experience:Minimum of two years experience in a health care customer service environment required. Experience in insurance or financial setting performing credit, collection and or billing functions preferred. Personal computer skills including Microsoft Word and Excel required.