Job description

Responsible for consistent commercial insurance follow-up of any claim(s) greater than 30 days, aged from final bill date, and resolution of same in a timely and cost-effective manner. This requires forming relationships with the individual insurance payers/clients in order to have the maximum response for timely and accurate payment. Monitor patient accounts assigned for accurate payment(s) or non-payment and take compliant actions for account reimbursement.
SHIFT AND SCHEDULE
Monday-Friday 8:00 AM - 5:00 PM

ESSENTIAL FUNCTIONS/PERFORMANCE EXPECTATIONS

• Able to read, understand and explain insurance carrier contracts and different types of reimbursement as well as accurately figure patient cost share for specific insurances.
• Able to understand, explain and handle referral/authorization issues, pre-authorization requirements, verifications, appeals, and medical necessity issues.
• Serves and protects the hospital community by adhering to hospital policies and procedures, federal, state and local requirements as well as DNV standards.
• Ability to read, understand and complete all A/R reports keeping up to date documentation of each patient account status in the patient account notes.
• Ability to respond timely to insurance and billing inquiries made in person, by mail or over the phone. Enhances Patient Account Department and hospital reputation by accepting ownership for accomplishing new and different requests while exploring opportunities to add value to job accomplishments.

EDUCATION AND EXPERIENCE

• High School diploma or equivalency required
• Courses in insurance billing/collections and medical terminology preferred.
• One-year hospital business office or physician business office experience preferred.
• Must be able to type 35 wpm and operate a personal computer with ability to use Microsoft Outlook, Excel and Microsoft Office.
• Must have basic math skills.

PHYSICAL REQUIREMENTS
To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The individual must be able to:

• Stand, walk, sit, stoop, reach, lift, see, speak and hear.
• Lifting is limited to 35 lbs. for clinical staff and to 50 lbs. for non-clinical staff.
• The individual must use an assisted-lift device or get another individual(s) to assist with the lift that is over these maximum limits.

Job Type: Full-time

Schedule:

• Monday to Friday

Work Location: In person

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