Responsible and accountable for accurate and timely follow up, including variances, no payments, denials for all payers on billed accounts receivable. Ensures accounts are followed up on in a timely manner with diligent focus on all including, but not limited to aged and high dollar accounts. Follows up and pursues identified payer variances after comparing expected to actual reimbursement received. Responsible for working with other departments when issues arise such as missing payments, payer delays, and technical denials. Demonstrates exceptional relationships with external payers and internal departments in accordance with Prisma Health Standard of Behaviours and Compliance.
Accountabilities
- Analyses and reviews prior account activity and takes necessary actions including calling payer or utilizing payer websites for current status of outstanding AR. Takes necessary actions to correct claim or obtain any requested information to the payer. Utilizes all appropriate workflows and completes appropriate and detail notes on every account preparing for next steps and/or resolution. 20%
- Performs daily duties related to collections, variances and/or technical denials in a manner that constantly drives the account towards resolution, while challenging unacceptable responses from payers. Understands, interprets and applies managed care contract terms to accounts for payer resolution. 20%
- Escalates accounts when appropriate, including but not limited with payer, internally and/or patient when appropriate in accordance with the Prisma Health escalation guidelines in order to minimize aging. 20%
- Demonstrates effective communication skills necessary for developing and maintaining positive professional relationships with team members, revenue cycle departments, clinical and corporate departments, payers, and industry organizations. 10%
- Identifies trends and repeated problems and/or charge corrections to management. 5%
- Maintains professional growth and development through seminars, workshops, in-service meetings, current literature and professional affiliations to keep abreast of latest trends in field of expertise.
- Actively contributes to PFS department matrix. Effectively utilizes time and resources, assisting co-workers as time allows. 5%
- Productivity and Quality of work must be met. Is attentive to detail and accuracy, is committed to excellence, looks for improvements continuously, monitors quality levels, finds root cause of quality problems and owns/acts on quality problems. 5%
- All policies and procedures will be strictly adhered to. HIPAA, security, dress code, etc. will be conscientiously followed. Understands, promotes and adheres to all matters of compliance with laws and regulations. High level demonstration of the Standards of Behaviours. 5%
- Communicates well both verbally and in writing, shares information with others and has good listening skills. 5%
Supervisory/Management Responsibilities
This is a non-management job that will report to a supervisor, manager, director or executive.
Minimum Education
High school diploma or equivalent OR post high school diploma
Minimum Experience
2 years – medical billing, customer service, follow up and/or medical office experience. Skilled in analyzing problems causing payment delays.
Other Required Skills
CRCA or CRCR – preferred.
Other Required Experience
Medical billing, follow up and/or medical office experience – required.
Work ShiftDay (United States of America)