Specialist (OBH), Cash Operations

Overview :

The Cash Operations Specialist will obtain appropriate reimbursement levels for professional services by analyzing denial and rejection reports and appeals whenever appropriate.

Works directly with practices, payors and patients to resolve claims. Address core issues driving denials or slow payments with appropriate staff.

Ability to assist in charge capture and charge entry if necessary.

Responsibilities :

Review and clear hold buckets for professional fee claims.

Develop expert knowledge of AthenaHealth practice management system.

Manage Medicaid pending and worker’s compensation claims support.

Develop relationships with key payor representatives for timely claim adjudication.

Develop relationships with practice plan personnel to assist in rectifying registration and coding related denials, and to acquire additional documentation for appeals.

Develop relationship with credentialing office to assist in clearing credentialing related bill holds.

Maintain a working knowledge of CPT-4 and ICD-9 / 10-CM coding principles, governmental regulations, protocols and third-party requirements pertaining to billing and documentation.

Answers patient and / or payor questions regarding billed amounts.

Provides accurate and concise communication to practices informing them of best practices.

Ensures maximum efficiency and reimbursement for properly documented services.

Reviews, modifies, and recommends changes to policies and procedures to improve professional fee billing and to maximize reimbursement.

Effectively manager A / R, bad debt, credit balance / refunds and collections.

Patient services and mails (sort and distribute).

Reconcile all payments (Bank, copayment) and produce financial month end reports.

Track, scan and upload payments to Athena.

Obtain Insurance Web access for all facilities (web portal, set up ERA / EFT, etc.).

All other duties as requested.

Qualifications : Education :

Education : Associates Degree.

Associates Degree.

OR Successful completion of an AHIMA approved Coding Certificate Program.

Experience :

Prior experience using AthenaHealth practice management or similar physician practice management system is required.

Minimum three (3) years of professional fee reimbursement experience is required.

Emergency Department, Radiology and Cardiology experience will be considered in lieu of certain other requirements.

Knowledge and Skills :

Must possess a thorough working knowledge of ICD-9 / 10-CM and CPT-4 coding systems as demonstrated by certification through AHIMA.

Knowledge of medical terminology, physician reimbursement models and medical abbreviations is required.

Ability to fully utilize BHMC’s electronic record systems, equipment and other healthcare and billing systems, as well as be proficient with Microsoft Windows and Microsoft Office.

Familiarity with physician practice management software (AthenHealth, EPIC, etc.) and electronic medical record a plus.

Ability to assist in translating physician orders to diagnosis or CPT-4 coding levels.

Licenses, Certifications :

Certification and Registration with the American Association of Medical Assistants, preferred.

Medical Assistant Certification preferred.

Physical Requirements :

Position requires prolonged periods of sitting and use of a computer and screen viewing throughout the working day.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The statements herein are intended to describe the general nature and level of work being performed by employees, and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified.

Furthermore, they do not establish a contract for employment and are subject to change at the discretion of The Brookdale Hospital Medical Center (BHMC).

BHMC is an equal opportunity employer, it is our policy to provide equal opportunity to all employees and applicants for employment without regard to race, color, religion, national origin, marital status, military status, age, gender, sexual orientation, disability or handicap or other characteristics protected by applicable federal, state, or local laws.