Job Description
The description below reflects the general duties considered necessary to describe the principle functions of the job as identified, and shall not be considered as a detailed description of all work requirements that may be necessary to complete the job requirements.
Ensures that claims, denials, and appeals are efficiently processed and reported on a regular schedule
Ensures that identified claim categories are prioritized to resolve billing-related issues
Manage staff to minimize bad debt, improve cash flow, and effectively manage accounts receivables
Stays apprised of coding and revenue trends; and is responsible for claim coding education to billing staff
Communicates professionally with various payers as needed
Participates in Joint Committee Meetings with contracted payers to identify and resolve billing, claims payment, claim denial issues
Develops, evaluates, implements and revises Departmental policy and procedures related to billing, reimbursement activities, and improvement strategies
Conducts monthly analysis of Medicare / Medicaid / Third Party Payers
Review and resolve issues related to claim generation and rejected / denied billings
Commit to highest level of business and patient confidentiality possible adhering to all HIPAA and security guidelines when accessing and sharing patient information
Keeps abreast of all reimbursement billing procedures of third-party and private insurance payers and government regulations
Maintains appropriate internal controls over accounts receivables
Monitors accounts sent for collection and reimbursement from insurance companies and other third-party vendors
Reviews, monitors and evaluates third-party reimbursement and researches variances
All other relevant duties as assigned
Requirements
QUALIFICATIONS :
Associates or B.S. Accounting / Finance, Healthcare Administration, or related field.
- 4+ years of on the job experience required.
- Understanding of hospital reimbursement and facility claims submission, collection and analysis (DRG, APC, Managed Care contracting)
- Hospital denials and appeals management experience
- Experience with managed care contracts, reimbursement and administrative terms and terminology
- High degree of proficiency utilizing and / or configuring hospital patient accounting, claims scrubber and contract management
- Excellent communication and interpersonal skills
- Experience working with Epic and ability to prepare Epic Revenue Cycle Reports
- Knowledge and experience with Excel
Union Position
Non-Union
Regular or Temporary
Regular
Salary Type (FLSA)
Exempt
Salary Range
$75,000
Position Type
Full-time
Position Number
IX055201
Home Department
Collection
Shift
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