Inspire health. Serve with compassion. Be the difference.

Job Summary

Accountabilities

• INSURANCE RESPONSIBILITIES:

  A. Assists in the processing of insurance claims including Medicaid/Medicare claims.

  B. Collects and enters patient's insurance information into database.

  C. Assists patients in completing all necessary forms.\u00A0 Answers patient questions and concerns.

  D.\u00A0 Reviews and verifies insurance claims.\u00A0 Requests refunds when appropriate.

  E.\u00A0 Processes Medicare correspondence, signature, and insurance forms.

  F.\u00A0 Follows-up with insurance companies and ensures claims are paid within timeframes as outlined in MA policies and procedures.

  G.\u00A0 Resubmits insurance claims that have received no response.

  H.\u00A0 Answers telephone, screens calls, takes messages, and provides information.

  I.\u00A0 Maintains files with referral slips, Medicare authorizations, and insurance slips.

• COLLECTION RESPONSIBILITIES:

  A.\u00A0 Identifies delinquent accounts, aging period and payment sources.\u00A0 Processes delinquent unpaid accounts by contacting patients and third party reimbursers.

  B.\u00A0 Reviews each account, credit reports and other information sources such as credit bureaus via computer.

  C.\u00A0 Performs various collection actions including contacting patients by phone and resubmitting claims to third party reimbursers.

  D.\u00A0 Evaluates patient financial status and establishes budget payment plans.\u00A0 Follows and reports status of delinquent accounts.

  E.\u00A0 Reviews accounts for possible assignment makes recommendation to Credit Manager and prepares information for collection agency.

  F.\u00A0 Assigns uncollectible accounts to collection agency or attorney via clinic Credit and Collection policy.\u00A0 Contacts lawyers involved in third-party litigation.

  G.\u00A0 Answers inquiries and correspondence from patients and insurance companies.\u00A0 Develops collection letters.

  H.\u00A0 Identifies and resolves patient billing complaints.\u00A0 Researches credit balances.

• CLAIMS RESPONSIBILITIES:

  A.\u00A0 Oversees claim processing and payments to third party providers.\u00A0 Answers associated correspondence.

  B.\u00A0 Monitors charges and verifies correct payment of claims and capitation deductions.

  C.\u00A0 Sends denial letters on claims and follow-up on requests for information.

  D.\u00A0 Audits and reviews claim payments reports for accuracy and compliance.

  E.\u00A0 Researches and resolves claim and capitation problems.

  F.\u00A0 Maintains timely provider information in physician files.\u00A0\u00A0\u00A0

  G.\u00A0 Maintains insurance company manual and distributes information to staff on updates and changes.

  H.\u00A0 Maintains required databases and patients accounts, reports and files.

  I.\u00A0\u00A0 Resolves misdirected payments and returns incorrect payments to sender.

  J.\u00A0 Answers patients inquires regarding account balances.

  K. Appeals denied claims adhering to payer policy while communicating with MAMC department for further assistance with claims resolution as appropriate.

  L.\u00A0 Works all assigned claims within designated time frame to ensure timely and appropriate payment

• BILLING RESPONSIBILITES:

  A. Researches all information needed to complete billing process including getting charge information from physicians.

  B.\u00A0 Works with other staff to follow-up on accounts until zero balance or turned over for collection.\u00A0\u00A0\u00A0\u00A0\u00A0

  C.\u00A0 Assists with coding and error resolution.

  D.\u00A0 Maintains required billing records, reports, and files.

  E.\u00A0 Investigates billing problems and formulates solutions.\u00A0 Verifies and maintains adjustment records.

  F.\u00A0 Maintains and enhances current knowledge of assigned payers with regard to guidelines for billing

  G.\u00A0 Provides training to front office staff when hired and retraining as needed or requested with regard to a specific payer rules and guidelines for physician billing.

  H.\u00A0 Recommends changes to departmental processes as necessary to maximize operational effectiveness of the revenue cycle.

• MISCELLANEOUS:

  1. Maintains strictest confidentiality.

  2. Participates in educational activities.

  3. Performs related work as required.

  4. As representative of Prisma Health Clinical Department, is expected to maintain neat and professional appearance, demonstrate commitment to serve at all times and uphold guidelines set forth in office manual.

Supervisory/Management Responsibility

This is a non-management job that will report to a supervisor, manager, director, or executive.

Minimum Requirements

• High School diploma or equivalent
• 2 years of experience in billing, bookkeeping, collections or customer service.

Required Certifications/Registrations/Licenses

N/A

In Lieu Of The Above Minimum Requirements

N/A

Other Required Skills and Experience

• Associate Degree in a technical specialty program of 18 months minimum in length\u00A0preferred
• Multi-specialty group practice setting experience preferred
• Intermediate ICD-9 and CPT coding abilities preferred
• Electronic Claims Billing experience

Work Shift

Location

Facility

Department

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

Inspire health. Serve with compassion. Be the difference.

Job Summary

Accountabilities

• INSURANCE RESPONSIBILITIES:

  A. Assists in the processing of insurance claims including Medicaid/Medicare claims.

  B. Collects and enters patient's insurance information into database.

  C. Assists patients in completing all necessary forms.\u00A0 Answers patient questions and concerns.

  D.\u00A0 Reviews and verifies insurance claims.\u00A0 Requests refunds when appropriate.

  E.\u00A0 Processes Medicare correspondence, signature, and insurance forms.

  F.\u00A0 Follows-up with insurance companies and ensures claims are paid within timeframes as outlined in MA policies and procedures.

  G.\u00A0 Resubmits insurance claims that have received no response.

  H.\u00A0 Answers telephone, screens calls, takes messages, and provides information.

  I.\u00A0 Maintains files with referral slips, Medicare authorizations, and insurance slips.

• COLLECTION RESPONSIBILITIES:

  A.\u00A0 Identifies delinquent accounts, aging period and payment sources.\u00A0 Processes delinquent unpaid accounts by contacting patients and third party reimbursers.

  B.\u00A0 Reviews each account, credit reports and other information sources such as credit bureaus via computer.

  C.\u00A0 Performs various collection actions including contacting patients by phone and resubmitting claims to third party reimbursers.

  D.\u00A0 Evaluates patient financial status and establishes budget payment plans.\u00A0 Follows and reports status of delinquent accounts.

  E.\u00A0 Reviews accounts for possible assignment makes recommendation to Credit Manager and prepares information for collection agency.

  F.\u00A0 Assigns uncollectible accounts to collection agency or attorney via clinic Credit and Collection policy.\u00A0 Contacts lawyers involved in third-party litigation.

  G.\u00A0 Answers inquiries and correspondence from patients and insurance companies.\u00A0 Develops collection letters.

  H.\u00A0 Identifies and resolves patient billing complaints.\u00A0 Researches credit balances.

• CLAIMS RESPONSIBILITIES:

  A.\u00A0 Oversees claim processing and payments to third party providers.\u00A0 Answers associated correspondence.

  B.\u00A0 Monitors charges and verifies correct payment of claims and capitation deductions.

  C.\u00A0 Sends denial letters on claims and follow-up on requests for information.

  D.\u00A0 Audits and reviews claim payments reports for accuracy and compliance.

  E.\u00A0 Researches and resolves claim and capitation problems.

  F.\u00A0 Maintains timely provider information in physician files.\u00A0\u00A0\u00A0

  G.\u00A0 Maintains insurance company manual and distributes information to staff on updates and changes.

  H.\u00A0 Maintains required databases and patients accounts, reports and files.

  I.\u00A0\u00A0 Resolves misdirected payments and returns incorrect payments to sender.

  J.\u00A0 Answers patients inquires regarding account balances.

  K. Appeals denied claims adhering to payer policy while communicating with MAMC department for further assistance with claims resolution as appropriate.

  L.\u00A0 Works all assigned claims within designated time frame to ensure timely and appropriate payment

• BILLING RESPONSIBILITES:

  A. Researches all information needed to complete billing process including getting charge information from physicians.

  B.\u00A0 Works with other staff to follow-up on accounts until zero balance or turned over for collection.\u00A0\u00A0\u00A0\u00A0\u00A0

  C.\u00A0 Assists with coding and error resolution.

  D.\u00A0 Maintains required billing records, reports, and files.

  E.\u00A0 Investigates billing problems and formulates solutions.\u00A0 Verifies and maintains adjustment records.

  F.\u00A0 Maintains and enhances current knowledge of assigned payers with regard to guidelines for billing

  G.\u00A0 Provides training to front office staff when hired and retraining as needed or requested with regard to a specific payer rules and guidelines for physician billing.

  H.\u00A0 Recommends changes to departmental processes as necessary to maximize operational effectiveness of the revenue cycle.

• MISCELLANEOUS:

  1. Maintains strictest confidentiality.

  2. Participates in educational activities.

  3. Performs related work as required.

  4. As representative of Prisma Health Clinical Department, is expected to maintain neat and professional appearance, demonstrate commitment to serve at all times and uphold guidelines set forth in office manual.

Supervisory/Management Responsibility

This is a non-management job that will report to a supervisor, manager, director, or executive.

Minimum Requirements

• High School diploma or equivalent
• 2 years of experience in billing, bookkeeping, collections or customer service.

Required Certifications/Registrations/Licenses

N/A

In Lieu Of The Above Minimum Requirements

N/A

Other Required Skills and Experience

• Associate Degree in a technical specialty program of 18 months minimum in length\u00A0preferred
• Multi-specialty group practice setting experience preferred
• Intermediate ICD-9 and CPT coding abilities preferred
• Electronic Claims Billing experience

Work Shift

Location

Facility

Department

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.