Inspire health. Serve with compassion. Be the difference.
Job Summary
Responsible for monitoring and/or resolution of high dollar, high profile, escalated accounts. Ensures timely and accurate posting, adjustments, correspondence, and/or denials. Ensures complete, accurate, and compliant processes resulting in optimal collection and customer service performance for the organization. Supports various special projects ensuring billing, AR, and denial prevention are optimal.Essential Functions
All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.
Monitors, research and/or resolves high dollar, high profile, and problem accounts, providing necessary information to various internal revenue cycle departments, clinical and corporate departments, and patients for resolution of account inquiries.
Monitors, reviews and provides analysis of all assigned work queues, dashboards and watch lists, payer communications and analysis, identifying trends and working with other departments to resolve system issues.
Demonstrates superior communication skills necessary for developing and maintaining positive professional relationships with team members, revenue cycle departments, clinical and corporate departments, payers, and industry organizations.
Evaluates payer performance and payment trends to provide management with valuable statistics to facilitate improved payer relations and contracting criteria, identifies payer specific problem trends and works with clinical departments, outcomes management, managed care, reimbursement and PFS to rectify systematic issues.
Facilitates, attends and/or participates in payer assigned meetings for improved payer relations and to identify and resolve payer processing, claims and denial issues. Assures timely communication of all meeting outcomes to appropriate PFS team members.
Attends appropriate meetings and training seminars to assure awareness and understanding of all billing regulations, compliance policies, industry changes, and/or payer reimbursement guidelines. Maintains professional growth and development through seminars, workshops, in-service meetings, current literature and professional affiliations to keep abreast of latest trends in field of expertise.
Recommends and assists in the development of regular training sessions with team members, to ensure highest quality and productivity standards are achievable. Assists in on boarding of new team members as well as providing ongoing support for all FS team members.
Identifies payer specific trends and works with revenue cycle, clinical and corporate departments, managed care and reimbursement teams on resolution.
Maintains strict adherence to department quality measures and timely and accurate completion of assigned responsibilities
Responsible and accountable for reconciliation and accuracy of vendor invoices, vendor staff set up in EPIC, vendor collection and expense reports.
Meets and exceeds the appropriate performance and productivity standards and key performance indications for the department. Demonstrates accurate and professional relationships with all Prisma Health patient accounts, ancillary departments and third party payers in accordance with Prisma Health Service Excellence, Standard of Behaviors and Compliance.
Performs other duties as assigned.
Supervisory/Management Responsibilities
This is a non-management job that will report to a supervisor, manager, director or executive.
Minimum Requirements
Education - High School diploma or equivalent OR post high school diploma / highest degree earned
Experience - Five (5) years revenue cycle, accounting experience including registration, billing, collections, credits, refunds, customer service, banking, finance, managed care or related area
In Lieu Of
NA
Required Certifications, Registrations, Licenses
CRCA preferred
CRCR preferred
Knowledge, Skills and Abilities
NA
Work Shift
Day (United States of America)Location
Patewood Outpt Ctr/Med OfficesFacility
7001 CorporateDepartment
70019012 Patient Financial ServicesShare your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.