Lead System Coordinator, Patient Accounts - Full Time

Description

The Lead System Coordinator, Patient Accounts, is responsible for providing support and oversight to the centralized billing office team by coordinating centralized business office operations related to managing the day-to-day processing and adjudication of professional and facility claims to payers. The Lead System Coordinator, Patient Accounts, must be able to review and understand all areas of claims billing, processing, and reimbursement/collections and must have a high level of ability to deal with complex claims issues. Must have experience with EOBs as well as all forms of insurance communication documents, ability to complete appeals competently for successful overturn of negative decisions, able to professionally communicate both verbally and through written correspondence with physicians’ offices, nurses, internal departments, insurance companies, and patients and employ strategies for optimal financial outcomes.

JOB-SPECIFIC RESPONSIBILITIES:

1. Performs ongoing quality assurance audits and reviews of billing and collection processes and ensures all aging reports are being maintained effectively and timely

2. Monitors timeliness and effectiveness of department activities, ensuring that outstanding patient accounts and accounts receivable are no more than the agreed-upon limit and that bad debt is within the budgeted target

3. Responds to telephone calls, working with those that are routine in nature, or routing the appropriate staff member as calls occur

4. Sets priorities and functional standards, giving direction to staff as necessary to ensure the best possible delivery of service and high customer satisfaction

5. Meets or exceeds threshold goal for the department

6. Analyzes operations to identify problematic activity impacting AR agings, denials, and write-offs for departments and physicians.

7. Facilitates and promotes effective team dynamics and team-building strategies within and between departments; participates and/or leads and facilitates department process improvements as needed.

8. Confirms admission documentation from the facilities and the CBO biller; the claim documentation is accurate compared to the assigned payer per contract guidelines.

9. Communicates internally/externally to obtain additional patient information to collect timely and per the contract.

10. Confirms claims were billed and received for accounts assigned.

11. Confirm claims submitted electronically have been received with no rejections.

12. Claims rejected or not confirmed received are to be requested from the biller immediately. Provide information to ensure the claim is submitted correctly to the biller.

13. Document collection efforts taken on each account billed for claims aged 60+ days. Collections or billing confirmation can be obtained via phone call to the payer, lockbox, or online. All actions taken must be noted.

14. Mandatory to work 35+ accounts from aging daily.

15. Responds to correspondence within 48 hours from the date of receipt.

16. Communicates with facility personnel to coordinate patient documentation required to appeal or rectify payments.

17. Forward denial correspondence to the appropriate staff to assist with appeals.

18. Files all bills, appeals, and communication to each patient/claim appropriately in the patient chart.

19. Identify credit balances monthly and prepare adjustments to refund appropriate credits before the end of each month for Federal and State-funded agencies. (Medicare, Managed Medicare, Medicaid, Managed Medicaid, DARS).

20. Credit balances on non-Federal or State Funded claims are to be prepared on the adjustment sheets and forwarded to Refund Pending, waiting for refund requests from payers.

21. Work accounts assigned on aging twice per month. Follow-up is required every 7-14 days, depending on how the claim was billed.

22. Pull paid accounts monthly from patient files to box and store. Confirm the file is complete and in order before boxing in the event the file is reviewed during any audit processes.

23. Identify any internal/external changes, processes, procedures, etc., that may create reimbursement issues.

24. Assists other CBO employees as necessary.

25. Performs all other duties as assigned.

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Job Requirements

Experience

  • Minimum of one year of experience in a hospital business office setting, or at least 3 years of experience in the medical billing/collection field.
  •  Medicare billing knowledge is preferred.

Education Required

  • A high school diploma or equivalent is required
  •  One to two years of college is preferred.