JOB PURPOSE:
Primarily responsible for effective collection on patient accounts, accounts receivable follow-up, and reimbursement analysis for all non-Government accounts.
ESSENTIAL FUNCTIONS INCLUDE BUT NOT LIMITED TO:
- Manage assigned accounts ensuring outstanding/pending claims are paid at maximum reimbursement in a timely manner.
- Request claims to be reprocessed where necessary or prepare and submit corrected claims to the insurance companies for payment.
- Follow-up on all outstanding insurance claims at 30-days from the date of service with an emphasis on maximizing patient satisfaction and client profitability.
- Review credit balance accounts for payer/patient refund requests and/or misapplied payments/adjustments.
- Follow up on all returned claims, correspondence, denials, account reconciliations and rebills within two working days of receipt to achieve maximum reimbursement in a timely manner.
- Communicate denials trends with Revenue Cycle Manager.
- Knowledge of insurance guidelines, including HMO/PPO, Medicare, and Medicaid.
- Obtain accurate and additional information from facilities as needed.
- Comply with state and federal regulations, laws and company policies and procedures.
- Help create, implement, and improve processes for the revenue cycle team.
- Maintain strictest confidentiality.
- Support management on special projects
- Other duties as assigned.
BEHAVIORAL STANDARDS:
- The individual must support the mission, vision, and goals of Avem Health Partners and serve as a role model within the company.
- Exhibit positive customer service behavior in everyday work interactions.
- Demonstrate a courteous and respectful attitude to internal workforce and external customers.
- Communicate accurately and appropriately.
- Handle difficult situations in a discreet and professional manner.
- Hold self-accountable for professional practice.
- Demonstrate knowledge of unit goals and is active in committees and projects to achieve these goals.
- Keep current with literature regarding changing practices, interventions, and best practices in patient care.
- Assume responsibility for seeking out educational and professional opportunities for personal learning needs and growth as well as meeting mandatory education requirements.
- Act as a preceptor as requested.
- Demonstrate excellent work attendance and attend and actively participate in a variety of meetings and training sessions as required.
- Adhere to the Avem Health Partners Code of Conduct and Standards of Behavior. Complies with established policies and procedures and all health and safety requirements.
EDUCATION:
- High school diploma or equivalent
- At least two years of medical accounts receivable experience
CERTIFICATION/LICENSURE:
- Medical billing certification, if available.
PHYSICAL REQUIREMENTS:
- To perform this job successfully, an individual must be able to perform each essential job duties satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant to be considered.
- This job requires visual abilities, auditory abilities, must be intact to perform duties.