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.
Handles a high volume of third party claims and ensures that accurate information is submitted to payers via the clearing house and/or payer intermediary in a timely manner to ensure prompt payment. Initiates the actions necessary to correct problems that prevent claims submission and/or contacts the individuals that are responsible for taking the corrective action to expedite claims processing. Documents all follow up activities on accounts in a clear and concise manner. Identifies and reports the trends of claim edits and rejections to the supervisor for further review. Performs a variety of duties necessary to resolve individual inpatient and outpatient balances. Keeps abreast of the changes to federal, state, and insurance regulations as well as maintains a general knowledge of billing and payment methodologies/guidelines. Has an understanding of the Revenue Cycle and how it functions. Performs all other duties as requested by supervisor.
- 1. Handles a high volume of third party claims, ensuring accurate information is submitted to payers via clearing house and/or payer intermediary. Initiates actions necessary to correct problems that prevent claims submission or contacts individuals responsible for taking corrective action and documents all actions appropriately.
- 2. Completes daily claims submission within timeframe designated by supervisor. Resubmits claims via clearing house or payer intermediary with updated or corrected information based on departmental request. Resolves all clearing house rejections from third party payers on a daily basis. Identifies and reports trends of claim edits and rejections to supervisor for further review.
- 3. Follows up on a high volume of paid and unpaid claims to expedite prompt and accurate payment based on established department workflows. Determines the reason for nonpayment and takes appropriate follow up action to ensure resolution. Documents all follow up activities on accounts in a clear and concise manner. Follow up activities are primarily performed via telephonic and web based methods of communication with all third party payers / self pay patients as well as internal communication with other hospital departments to facilitate payment of claims.
- 4. Performs a variety of duties necessary to resolve individual inpatient and outpatient credit balances based on departmental procedure. Posts adjustments to maintain the integrity of the account as required.
- 5. Maintains general knowledge of medical billing requirements, payer payment methodologies, and self pay billing guidelines. Keeps abreast of changes to federal, state, and insurance regulations.
- 6. Performs all other duties as requested including: Identifies problem and delinquent accounts after exhausting all avenues of collections and advises Supervisor of the need for intervention. Recognizes problem areas and trends that impact account resolution and makes suggestions for improvements. Actively participates in staff meetings, seminars, training sessions, and workgroups to advance departmental goals.
(number of years and type required to perform the position duties): High school diploma required. Associate Degree in business related field preferred.
One (1) to two (2) years of third party claims management and/or billing experience in a computerized hospital/healthcare revenue cycle environment preferably Epic.
Extensive knowledge of third party insurance carriers and their billing and reimbursement requirements. Excellent analytical and organizational skills. Demonstrated ability to perform detailed analysis quickly and accurately in a high volume, fast paced environment. Ability to communicate effectively both written and verbally. Microsoft Office skills preferred. Proven ability to effectively navigate various payer websites and other web based applications.