Self-Pay Analyst

New Haven, CT
Feb 12, 2019


Job Description

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values-integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.


Responsible for collecting self pay balances and retrospectively reviewing potential bad debt accounts prior to turnover. Contacts patients and/or third party carriers in order to collect accounts to maximize cash flow and reduce bad debt. Takes appropriate action to resolve account balances and collect self pay balances while ensuring the hospital's image of good customer relations is maintained at the highest level. Reviews payment of claims on remittances to ensure maximum third party reimbursement of accounts to correctly identify self pay balances. Makes assessment of financial status to determine course of action. Discusses patient payment options and obtains credit card payments from patients over the telephone. Advises patient of Free Care and Discounted Care options, initiating the process when appropriate. Refers self pay accounts for turnover to agency/attorneys. Complies with all HIPPA verification procedures to identify patient/appropriate party prior to providing information.

  • 1. Audits accounts in self pay file to insure accuracy of balance and makes timely demand for payment of account.
  • 1.1. According to established guidelines, performs "matching" function to combine self pay balances for a particular guarantor to be worked together.
  • 1.2. Properly cross-references patient accounts based upon guarantor information.
  • 1.3. Verify that the patient is not eligible for Medicaid by following established procedures referring to the on-line eligibility report.
  • 1.4. Reviews residual and self pay accounts to ensure accuracy of balance.
  • 1.5. Verify the identity of patient/appropriate party prior to providing information in order to be HIPPA compliant.
  • 1.6. Contacts patient to arrange payment in full or installments in accordance with credit and collection policy and established guidelines.
  • 1.7. Refers all accounts without prospect of voluntary payment to the next level of collections within established timeframes with all necessary information for turnover documented in the system.
  • 2. Works with patients and/or representative to determine if a settlement can be reached regarding an account, advises supervision when necessary to approve terms. Refers all accounts without prospect of voluntary payment to the next level of collections within established time frames with all necessary information for turnover documented in the system.
  • 2.1. Contacts patient to arrange payment in full or installments in accordance with credit card collection policy and established guidelines. Verifies the identity of patient/appropriate party prior to providing information in order to be HIPPA compliant.
  • 2.2. Verify that the patient is not eligible for Medicaid or if patient meets the definition of -uninsured-. Mails Free Care / Discounted Care packets and requests for supporting documentation to the patient/guarantor. Categorizes Pre-Bad Debt Accounts that meet the definition of -uninsured- from expected turnover.
  • 2.3. Identifies problem and delinquent accounts after exhausting all avenues of collections, advises supervision of the need for intervention or refers self pay account for turnover.
  • 3. Uses established follow up procedures to effectively expedite the prompt payment of claims by third parties and self pay patients. Recognizes problem areas and trends which deter the follow-up or collection effort and effectively communicates these to the supervisor.
  • 3.1. Utilizes the computer system to access daily work file to identify accounts requiring follow up activity.
  • 3.2. Initiates effective follow up via telephone contacts and/or written correspondence with potential bad debt patients and/or their representatives
  • 3.3. Ensures subsequent follow up activity is established and adheres to a timely schedule of follow-up as monitored by supervisor.
  • 3.4. Documents all follow up activity on the account in the system in a clear and concise manner to aid in the resolution of the account and for future review as observed directly or indirectly by the supervisor.
  • 4. Analyzes correspondence and problems as they pertain to accounts and takes corrective action to ensure proper maintenance of account and facilitate payment.
  • 4.1. Reviews and responds to internal and external mail/data/electronic mail within five (5) working days of receipt and returns telephone calls within 24 hours or the next working day.
  • 4.2. Reviews mail return and skip trace demographics to make every attempt to contact the patient prior to turning over. Employs a variety of systems and checks (i.e. eligibility, address, credit, etc.) to determine if patient qualifies for charity programs prior to turning account over. Verifies employment and assess property with detailed documentation pertaining to volume, page, and assessment value.
  • 4.3. Refers accounts to the appropriate party based on information provided in correspondence (i.e. Completed Free Care Applications, Additional Third Party Insurance Information, Patient Complaints, Legal Issues, etc.) in a timely manner. Makes referrals to the appropriate coordinator when supporting documentation is obtained.
  • 5. Keeps abreast of changing federal, state and insurance regulations and the guidelines to capitated and managed care contracts in a dynamic healthcare environment as well as credit and collection policies and charity care regulations. Keeps informed on policies and procedures pertaining to the credit reporting process. Reviews all memo and policy updates regarding per diem rates, DRG payment, percentage payments, case rate payments, and various UB04 revenue codes and any combination of these plans as well as the fee for service payment contracts, as they are distributed by the supervisor, to ensure currently billing procedures are followed. Maintains knowledge of general bankruptcy information and key federal bankruptcy codes.
  • 5.1. Accepts responsibility to maintain/update follow up/collections procedures pertaining to third party, state and federal billing and payment regulations and other contract guidelines and credit and collection policies and regulations.
  • 5.2. Informs supervisor of any pertinent information or problems as they arise to ensure the efficient operation of the department
  • 5.3. Utilizes Epic Follow Up Work Queues and/or Excel to produce monthly accounts receivable reports.
  • 5.4. Exhibits a positive attitude as it relates to interaction with co-workers, performance of job responsibilities, and a genuine interest in the proper performance of the job.
  • 5.5. Actively participates in all staff meetings, seminars, training sessions and work teams or task forces related to computer systems or procedures.

    Other information:

    High school graduate with courses in Business, Associate's degree in a Business related field preferred, or equivalent work experience.

    Two (2) to three (3) years experience in hospital/healthcare computerized accounts receivable environment or 3 years comparable collection environment Required

    Ability to communicate effectively with patient/third parties to obtain payment. Knowledge of third party insurance carriers and their billing and reimbursement requirements. Excellent analytical and mathematical skills with a high degree of accuracy. Ability to perform detailed analysis quickly and accurately. Knowledge of general bankruptcy information and key federal bankruptcy codes, Free Care and credit and collection guidelines. PC skills including Microsoft Office.

    Responsible to insure accuracy of self pay balances and make timely demand for payment of account. Incumbent is responsible for the timeliness and accuracy of the collection of accounts in assigned work file. Must contact patients to collect balances and determine the course of action for account based upon a financial assessment. Makes effective recommendations for the turnover of account to the appropriate agency/attorney.

    Highly organized individual with the ability to analyze data, problems and exercise sound judgment. Capable of using analytical skills and resourcefulness to accomplish many tasks and balance multiple priorities in a tense, highly active environment. Ability to deal professionally (through verbal or written communication) with other departments third party carriers and other agencies to resolve complex payment issues due to capitated and managed care contracts. Must be prepared to contact patients to collect self pay balances, discuss free care options and refer bad debt accounts to collection agencies/attorneys.

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    Job Info

    Job: 5338

    Department: SBO Collections
    Category: Finance
    Status: Full Time
    Shift: DAYS
    Hours: 40.00