Education: Associates Degree in Business or Healthcare field preferred. Will consider high school graduate with two years medical office experience.
Experience: Minimum of two years of related experience in customer service, healthcare or business field required.
Keyboard – Computer Skills
Intermediate keyboard, mouse and computer skills required with basic to intermediate Microsoft Office skills. Must have knowledge and ability to learn, access and utilize the relevant computer programs listed below within 90 days of hire:
· Internet/Web Browser
· Microsoft Office
· Star Navigator
· Claims Administrator
· OTG Application Xtender
· PCPrintAccounts Receivable Analysis database
Medicare team members will be required to navigate DDE/FISS.
Commercial team members will need to navigate the websites for Priority Health, Cofinity, Tricare, Federal Work Comp, and United Healthcare.
Blue Cross team members will need to be able to access the BC Research website and FCC.
Medicaid team members will be required to navigate the Michigan Medicaid online CHAMPS system
Medical Terminology required or successful completion of medical terminology course within 180 days of hire.
Above average oral and written communication skills needed; ability to converse well on the telephone and in face-to-face situations. Must be warm, friendly and sensitive to the feelings and concerns of others.
The ability to functions responsibility in a minimally supervised work situation and utilize proven decision making skills are required.
Intermediate math skills are required.
The applicants must have a current knowledge of third-party payer reimbursements.
The applicants must be self-starters and be able to function with minimal supervision.
Daily contact and interaction with other departments within Munson Medical Center and other internal/external customers. Must possess a team orientation for goal achievement.
Work processes are discussed weekly as a team with Coordinator/Manager.
Supports the Mission, Vision and Values of Munson Healthcare
Embraces and supports the Performance Improvement philosophy of Munson Healthcare.
Promotes personal and patient safety.
Has basic understanding of Relationship-Based Care (RBC) principles, meets expectations outlined in Commitment To My Co-workers, and supports RBC unit action plans.
Uses effective customer service/interpersonal skills at all times.
Able to establish priorities and meet tight deadlines with strong problem solving ability.
Keeps current with changing insurance benefits and coding, and shares pertinent information with billing team members.
Completes transmission process on electronic billing system for all current claims. Prepares and mails required hard copy claims to insurance companies, patients and/or other responsible parties. These processes will be completed within 48 hours of arrival, excluding holidays and weekends. Exceptions will be claims that require intervention by the charging departments, Quality Management or require coding via Medical Records/Health Information Managements.
Process claim rejections within 7 days of receipt.
Follow-ups reviewed and necessary rebilling will occur every 30 days after the initial 45/60 day-processing period.
Control A/R days without billing balance to a set goal.
Control claims over 90 days to meet goal.
Review and document procedures as appropriate.
Review rejections to ensure compliance with third party payers and take concerns to management.
Produce credit reports quarterly as required by Medicare. Report all credit balances to the appropriate insurance payer and process according to the payer's requirements within 30 days.
Demonstrates understanding of Hospital reimbursement contracts. Using Plan, determines if the payment received is in accordance with the third party payors required reimbursement. Disposition payments and adjustments to produce statements for secondary payers or patient balances. Guides and instructs fellow employees and Patient Accounts on A/R transactions and interpretation of payment vouchers.
Processes coordination of benefits claims, complying with no-fault rules and regulations and all third party payers' guidelines, in a timely manner.
Generates statistical reports.
Controls and audits all adjustments to the accounts receivable from the Business Office.
Analyzes and initiates corrective action for patient claims. This analysis includes: auditing charges i.e. 72/24 hour requirements, payments and contractual agreements. Must be able to resolve payment questions with insurance companies.
Verifies insurance benefits on problem accounts and assists patients resolve MSP/COB issues.
Requires lab and radiology order in OTG to confirm appropriate charges applied to accounts.
Reviews orders in OTG to identify additional diagnosis codes not added to accounts.
Reviews records in Power Chart to confirm services as separate and distinct when multiple charges have been added to an account.
Reviews records in Power Chart to resolve 3M CCI edit problems.
Uses Power Chart to collect and print records to send with all hard copy Auto Accident and Workers' Comp claims.
May provide billing services for multiple facilities.
Reports to financial class billing coordinator and should support team structure with emphasis on commitment to my co-worker.
Performs other duties and responsibilities as assigned.