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Description

MONDAY-FRIDAY 8:00AM -5:00 PM

Summary & Objective

The Specialist, Collection is responsible for performing all billing and collection functions related to Medicare, Medicaid, Private Pay, and Self Pay.

The Specialist is responsible for performing pre-billing audits for all insurances and Medicare Advantage accounts to release clean claims for billing, to prevent rejections and to ensure timely submission and reimbursement. Review the visit notes; make sure they are in completed status communicating with the proper party to resolve issues holding up billing. Correct and complete any missing information related to clients EMRs. Confirm authorizations are obtained and approved for the billing period. Follow up with medical records Manager on authorization that are in pending approval status and orders that are not back signed. Prepare clients medical records for upload through the insurance portal prior to releasing the claims for billing. Complete and update the discharge information as needed when necessary to move claims to 'Ready for billing' status.

Essential Functions

• Researches and analyzes accounts prior to releasing claims for Billing. examines historical data, evaluates past collection efforts.
• Access multiple databases for obtaining account status or entering data on assigned accounts; verifies accuracy before and after entry.
• Determines most effective and economical means of collection for each account; applies standard due diligence practices to collect monies owed; composes correspondence requiring knowledge of procedures and practices in collections and also sends a variety of standard collection letters.
• Coordinates with Admissions, Patient Care and Social Services Departments on Medicare, Medicaid, private insurance, HMO and self-pay patients to obtain pre-billing information and approvals, to collect documentation and update billing files.
• Provides financial counseling to discuss and resolve the debt situation; restructures or revises payment terms within well-established limits and procedures; recommends hardship or other deferments when appropriate to supervisor.
• Applies payments received to proper accounts, keeping accurate accounting records of each transaction; reconciles records with computer reports, makes necessary adjustments or corrections.
• Assists Reimbursement Manager with Medicaid application by compiling necessary documentation and attending the designated appointments with the Department of Children and Families.
• Maintains billing files with up-to-date supporting documentation in compliance with insurer requirements.
• Maintains files (electronic and/or hard copy) on all past due accounts, documenting details of methods utilized to secure payment.
• Compiles information and prepares a variety of reports on collection activities for supervisor, such as outstanding accounts and their current standing.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position.

Other Duties

• Generates reports related to billing from the EMR software program as required.
• Serves as a back up to Reimbursement Coordinator
• Must employ independent judgment to determine or ensure most efficient and cost-effective approach to account resolutions.
• Must possess general and detailed knowledge-base of insurance related collection strategies and be assertive when faced with claims related rejections.
• Experienced in proper appeals related procedures for both governmental and private insurance companies.
• Must be able to leverage efficiencies by establishing priorities and insuring seamless process compliance.
• Handle sensitive information and maintain confidentiality.
• Manage multiple projects simultaneously and meet hard deadlines.
• Adapt to change/new processes as necessary for continuous process improvement.
• Work product must be accurate and is subject to random and frequent auditing - internal, external and self.
• Must be able to express creativity with problem resolution, while maintaining an open-mind to new ideas.
• Work collaboratively with Admissions, Community Relations, and Interdisciplinary Team Managers and members to develop and integrate process improvement.
• Continual and proactive knowledge seeker to insure most accurate and up-to-date policies and practices both within the organization and related legislative rulings.
• Ability and willingness to work a flexible Full-Time schedule that may include weekends and Holidays.
• Maintain your required licenses, certifications and mandatory skill updates.
• Comply with all policies, local, state and federal laws and regulations.
• Provide other duties of healthcare team member
• Perform other duties as assigned

Supervisory Responsibility

• May serve as an interim department leader depending on need

Physical Requirements

• Must be able to lift and/or move up to 50 pounds and push/pull up to 250+ pounds, walk, climb stair or ladders, stand on feet for extended periods of time, etc.

Disclaimer

The job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time.

EEOC Statement

CHS provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Requirements

Knowledge & Experience Requirements

• Advanced degree, certificate or relevant experience in Finance, or Accounting preferred.
• Minimum of 5 years' experience in Keep up to date in billing requirements changes per CMS regulations and per insurance contracts and agreements and collections in an institutional health care organization with knowledge of 3rd party payer system.
• Experience in Medicare, Medicaid and other third-party billing preferred.
• Knowledge of Medicare billing regulations and eligibility preferred.
• Experience with Medicare DDE, eServices and Availity to determine clients coverage, benefits and eligibility.
• Must have knowledge of computer office/clinical software
• Must be able to read, write and understand the English language