Patient Financial Services Specialist, 8am-4:30pm, 40hrs/wk, Lincoln

Patient Financial Services Specialist, 8am-4:30pm, 40hrs/wk, Lincoln

Job ID: 0007M1

Full Time - Day

Job Description

JOB DESCRIPTION
Job Title: Patient Financial Services Specialist
Job Code: 880073
Immediate Supervisor: Patient Financial Services Manager
Status: Non-exempt
DEPARTMENT FUNCTION/JOB OVERVIEW
Responsible for accurate and timely filing of claims to commercial, government and contracted payers. Accountable for working claim edits timely and accurately, ensuring correct filing and adequate reimbursement. Responsible for helping patients with billing questions and providing information about payment options and resources. May be responsible for data entry of charges and/or patient information. Maintains knowledge billing requirements and/or reimbursement methodologies for multiple levels of care, including but not limited to MS-DRG, CMG, RUGS, Case Mix, Long Term Care, Outpatient and physician billing is essential. Understands and complies with federal and state billing regulations. Accountable for claim denial resolution. Work will be performed in an ethical and legal manner following organizational policies, processes, protocols and procedures. This position represents Madonna by adhering and upholding the organization’s Mission, Vision and Values. Supports co-workers, engages in positive interactions and provides helpful assistance to all customers.
ESSENTIAL FUNCTIONS

• Prepare and process insurance claims timely and accurately to government, commercial and managed care payers.
• Review and process corrected claims as appropriate.
• Maintain responsibility for assigned claims, from submission to final payment.
• Enter appropriate account notes in the patient accounting system to clarify collection efforts.
• Resolve claim edits in the patient accounting system and/or external billing software (clearinghouse).
• Verify eligibility for coverage via multiple payor websites.
• Ensure compliance with payer billing requirements.
• Enter coded professional charges in the patient accounting system.
• Verify accuracy of patient information in the patient accounting system.
• Maintain current and complete knowledge of the accounts receivable system.
• Analyze and review patient and third party payor payments for accuracy.
• Post and log patient and third party payor payments, adjustments and refunds.
• Research and analyze all third party payor payments to verify accuracy and resubmit appeals or bill next payer/patient as appropriate.
• Analyze, compute, and coordinate appropriate claims adjustments.
• Originate and expediently process Medicare No-Pay and Demand bills as necessary to comply with Medicare regulations.
• Remain current with rules and regulations for professional and/or hospital billing.
• Appropriately research and code MSP claims to comply with Medicare Secondary Claims regulations.
• Verify accuracy of patient days and process Hospital Reserve Day letters as necessary to comply with Medicare regulations.
• Research, and monitor accounts to allow for timely processing of estate demands and/or liability liens within guidelines to safeguard maximum reimbursement due to Madonna.
• Review, research and take action to resolve credit balances, including payer notification and/or refund.
• Monitor and process medical documentation/requests, secondary payor information, or any other requests as received to expedite payment and complaint customer requests.
• Maintain responsibility for correspondence, which may include providing additional information to process claims and/or refunds, sending itemized billing statements, and filing authorizations.
• Assist patients, other Madonna departments and external parties with billing questions, requests or payments via phone, email or in person as requested.This includes: education to patients, as appropriate, on Madonna’s financial assistance policy and payment plan options.
• Communicate claim and/or collection issues to Patient Financial Services leader and/or designee for collaboration and resolution.
• Follow instruction from Patient Financial Services Director, Manager and/or designee to perform other functions as assigned.
• Demonstrate proficient computer skills, including e-mail, word processing, spreadsheets and/or healthcare claims/billing software.
  PHYSICAL DEMANDS AND ENVIRONMENTAL CONDITIONS
  Light Work - Walk/stand constantly while stooping, pulling/ pushing file cabinets, reaching/climbing to retrieve computer printouts/storage material, twisting at desk to reach, type, answer phone, and occasional lifting of approximately 20 pounds. Manual dexterity and acuity for computer entry. Requires sufficient sight to see and read reports and computer screen. Requires sufficient hearing and speaking to communicate by phone or in person. Inside office setting with noise from numerous telephones, keyboards, printers and simultaneous conversations.
  QUALIFICATIONS (Education/training and/or Experience)
  High school diploma or equivalency required. One year related work experience in health care billing and reimbursement or health care related field preferred. Current knowledge of Medicare, Medicaid, Workers Compensation or/or commercial insurance billing and reimbursement principles preferred. Requires strong skills in oral and written communication, math, reading, spelling and basic understanding of accounting principles. Attention to detail and excellent customer services skills required. Must be self-motivated and demonstrate good organizational, problem solving and communication abilities. Demonstrated computer skills required with basic knowledge of Excel spreadsheet and Word processing, proficient use of 10 key calculator and ability to operate various office machines. Must have ability to work well in demanding situations and interact in positive manner with staff and public.
  Background checks are conducted. When specific authorization forms are requested so that full background and history can be obtained, employees/applicants must sign the form(s) requested.

Requirements

No additional requirements from any stated in the above description.