· Timely follow-up on hospital patient accounts that are outstanding for insurance payment, including but not limited to the following processes: verify claim payment status, rebill to patient’s insurance, proration to correct financial class and notation of patient accounts with steps taken for resolution
· Work an average of 40-50 accounts per workday for assigned payor(s)
· Assigned Payor denials and Zero ($0) pay reports worked within 24 hours of receipt
· Gather additional demographic, clinical information, medical records, authorizations, and insurance related information deemed necessary to pay outstanding medical claims and update the applicable systems with the patient’s information
· Ability to prioritize job responsibilities and manage time effectively for completion of assignments
•
•
Analyze, communicate, and participate in resolving denial/variance trends and payor issues with other teams/departments within the organization
· Identifies and prepares less complex claims for reconsiderations and appeals
· Assists leadership in managing assigned A/R and ensure resolution of outstanding insurance balances at 90 days post discharge
•
•
Works closely with third party payors and takes next steps to reach resolution of outstanding insurance balances.
•
•
Must have the ability to deliver education and training for new hires along with assisting less experienced representatives.
· Perform research on patient accounts with outstanding insurance balances and route patient accounts through appropriate workflows
· Review and recommend adjustments to accounts in accordance with the payor, company, and client guidelines
· Participate in and complete projects assigned by team lead or manager to fulfill clients’ contractual agreement of services
· Work in partnership with other teams/departments regarding resolution of project issues, concerns, and workflows
· Maintain the effectiveness and implementation of the MEDHOST Quality Management System and meet applicable regulatory requirements as needed
· Responsible for QMS procedures listed in QMS Procedure Crosswalk found in QMS Manual as applicable.
· Attend role-based education courses within the calendar year
•
•
Assists leadership with special projects and/or stretch assignments
· Accurately input/submit worked time by the required departmental deadlines
· Maintain knowledge of insurance payors and collection regulations
· Maintain industry knowledge through self-study and by attending training classes
· Attend and participate in team and departmental meetings
· Effectively responds to emails, telephone calls, voicemails, Microsoft Teams messages, and correspondence from patients, agencies, and facilities in a timely manner
· Adherence to all HIPAA Privacy and Security requirements and responsibilities
· Perform duties and responsibilities in a positive manner that upholds company policies and procedures