Accurately post all claims from physician’s office.
Insurance Claim Management:
Files claims from receipt of charges. Submits claims on a daily basis – on accounts where charges are received daily.
Verify audit trail reports from electronic claim filing
Institutes corrective action of audit trail exceptions prior to verification
Provides follow-up and corrective action on all claims
Maintains files, records in organized orderly manner.
Patient Account Management:
Transfers accurate balance from insurance account to patient account at time of insurance payment postings or upon receipt of appropriate denials.
Manages patient balances in accordance with practice policy and physician instruction.
Provides monthly review and recommendations to physician(s) regarding delinquent patient balances and noteworthy patient contact.
Routinely performs insignificant balance write-offs once per month per physician policy.
Communication and Coordination with Physician Office Staff:
Communicates with physician(s) office staff weekly (or more often as needed) regarding
Insurance denials, rejections resulting from errors in patient Masterfile/insurance policy information.
Performs monthly review with physician(s) regarding charges, payer mix, office collections, A/R aging, changes in reimbursement policy, payments by insurance class, producer, general recommendations.
Assists with the training process of new and existing physician office staff.
Works routinely toward maximizing efficiency and cost effectiveness of activities
Recommends action or payment plans on overdue patient accounts with no payment history, also in conjunction with the collection process.
Develops cooperative relations with office staff to effect accurate patient information.
Recommends policy, procedures, and ideas to improve Practice Advantage performance.
Volunteer’s assistance support to co-workers as need indicates.
Maintains up-to-date manual of billing procedure practices unique to account.
Uses personal transportation for office courier service to DCH facilities and clients’ offices.
MINIMUM KNOWLEDGE, SKILLS, EXPERIENCE REQUIRED
High School Diploma or General Education Degree (GED) required. Minimum six (6) months clerical experience required. Ability to read and comprehend instructions, short correspondence and memos. Excellent written and verbal communication skills required. Ability to effectively present information in one on one and small group meetings to clients and staff. Able to Multi-tasking, prioritization, time management and critical thinking skills required. Proficient computer skills, Microsoft Office Suites. Must be able to use personal transportation to provide courier services for the office. Strong Customer Service skills and ability to answering both patient and insurance company questions. Able to analyze problems and strategize for better solutions.
Physical presence onsite is essential. Hearing and vision must be normal or corrected to within normal range. Able to perform the duties with or without reasonable accommodation. Valid drivers and automobile liability insurance. Very good interpersonal communication and customer service skills required.
Physical: Medium work – Exerting 20 – 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to more objects. Physical Demand requirements are in excess of those for Light Work. Good manual and finger dexterity. Ability to tolerate prolonged periods of sitting. Some light driving required.
Psychological: Contact with Others, Deal with external customers/clients, sometimes dealing with unpleasant people, occasionally coordinating letters/memos, working with work groups or as a Team constantly/consistently.
- Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
- Performs compliance requirements as outlined in the Employee Handbook
- Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
- Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
- Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.
- Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.
- Requires use of electronic mail, time and attendance software, learning management software and intranet.
- Must adhere to all DCH Health System policies and procedures.
- All other duties as assigned.