A/R Specialist Level I - CVPH Medical Center (Plattsburgh, NY) in Plattsburgh, New York For Sale

Overview: Responsible for billing and collecting inpatient and outpatient accounts according to established policy and procedure. In addition, is responsible for accurately maintaining account balances on a daily basis, as well as staying current with constantly changing rules and regulations in order to ensure prompt collection of monies due the Medical Center. Special Criteria Details: Working no more than 832 hours per year Responsibilities: Bills patients and third party insurances in compliance with applicable regulations and contractual agreements. Demonstrates thorough understanding of patient accounting and electronic billing information systems. Responsible for communicating any system or edit issues to the appropriate party. Responsible for seeing that everything which is available to be billed on a daily basis is billed within 48 hours (with the exception of series accounts which are to be billed as soon as possible). This includes newly billable accounts, secondary bills and other transfers and rebills. Demonstrates a thorough understanding of all applicable insurance regulations and contractual requirements and reviews all appropriate insurance bulletins in a timely manner. Responsible for communicating any significant billing or insurance issue to the manager in a timely manner. Verifies that accurate and complete information is included on the claim form in accordance with specific payor requirements. Responsible for communicating any significant registration, charge entry or coding issues which may be identified to the manager in a timely manner. Adjust charges on accounts when appropriate. Works late charge reports on a daily basis. Researches the legitimacy of late charges and posts to the appropriate account; correcting insurance and patient balances as required. Credits charges on accounts only if proper authorization is provided to substantiate the credit adjustment. For charges which have been inadvertently posted to the improper account, locate the correct account and adjust charges as needed. Resubmit bills for adjusted accounts. Processes insurance rejections, denials or requests for additional information in a timely manner. Responsible for changing financial class, transferring balances to other insurance or patient and documenting account for all appropriate rejections. Responsible for providing Utilization Review and/or Medical Records with any relevant denial information or correspondence. Responsible for following up with patient or insurance company or providing missing information for questionable rejections and submitting rebills as needed. Files appeals to insurance company for any denial reason we don't accept as valid. May also include working with the patient to assist in resolving claim. Processes payment remittance including calculating contractual allowances and verifying accuracy of payments in a timely manner. Responsible for calculating contractual allowances and verifying accuracy of payments in accordance with the terms of individual insurance contracts. If payment is correct, responsible for changing the financial class, transferring balances appropriately and documenting the nature of the remaining balance. If payment is incorrect, responsible for following up with insurance company to assure complete payments are received. Demonstrates accountability for assigned accounts. Identifies all accounts which have been billed and for which there is still an open balance and follows up with rebilling or otherwise communicating with insurance companies and/or patients as appropriate. Communicates any unusual or significant insurance issues to manager in a timely manner. Communicates any unusual issues affecting workload to manager in a timely manner and is able to communicate the status of workload including backlogs and the reasons why backlogs exist. Is also able to develop and implement a plan for elimination of workload backlogs. Courteously handles incoming phone calls; answering questions, providing information and recording billed related information as appropriate. Answers phone courteously and promptly. Answers inquiries from patients and insurance companies. Educates patients with regards to billing and insurance requirements whenever possible. Records patient concerns that cannot be answered by a biller to forward to the appropriate party; makes patient aware of the fact that the concern will be investigated and who they may expect to receive a response from. Updates accounts with any additional or corrected information obtained from patients or insurances. Documents nature of conversation on account when appropriate, including all relevant details. Refers phone calls to appropriate party if unable to answer or satisfy caller. Obtains credit card information and sends through proper channels for processing and posting payment to the account(s). Other duties as assigned. Qualifications: High School graduate or equivalent. Good communication, organizational and telephone skills required. Proficient in the use of Microsoft Word as evidenced by completion of a course. Ability to type 40WPM with no more than three errors required. 1 year medical billing experience including electronic claims submission and follow-up with payers required OR an AA degree in Accounting or Finance or Business Administration. Ability to make appropriate decisions with a minimum amount of supervisory direction required. Thoroughness, attention to detail, and follow through is required until accounts are resolved. Workload requires ability to handle several thousand accounts. 1 year of customer service experience is required. Flexibility and handling multiple tasks at once is required. As applicable, the individual has training/competency in attending to the special needs and/or behaviors appropriate to the age of the patients for which care is being provided. Options:
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