The posting
Job Purpose The representative is responsible for collections, account follow up, billing allowance posting for the accounts assigned to them. Duties and Responsibilities
Bedside interviews conducted for all emergency room, inpatient, and observation patients with a possible (MVA/WC/self-pay trauma) financial classes Interview all walk-ins at the Financial Counseling Unit related to (MVA/WC/self-pay trauma) Uses collections system, client host system and other tools available to them to collect payments and resolve accounts Follow-up on NJ PLIGA application statuses until approval is obtained Working knowledge of the insurance follow-up process with understanding of the fundamental concepts in healthcare reimbursement methodologies Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites Retrieve Medical Records from the Patient Accounts Department Verifies that information is accurate as to individual or insurance company responsible for payment of bill. Interact with the Utilization and Care Coordination department to share information with the Social workers and case Managers. Assist in responding to daily emails related to MVA/WC to ensure requests for patient related issues are completed timely. Monitors all billings for accuracy, updating any that contain known errors. Bills all hospital services to insurers or patient correctly and within expected timeframe Follows up with insurance companies on all assigned accounts within expected timeframe Explains hospital regulations with regard to methods for payment of accounts and maintains complete working knowledge of insurance regulations and hospital insurance contracts Identify and report underpayments and denial trends Ability to analyze, identify and resolve issues causing payer payment delays and initiate appeals when necessary Basic knowledge of healthcare claims processing including: ICD-9/10, CPT and HCPC codes, as well as UB-04 Meets and maintains daily productivity and quality standards established in departmental policies Act professionally, cooperatively and courteously with patients, insurance payors, co-workers, management and clients Perform special projects and other duties as needed by the management team. Maintain confidentiality at all times Use, protect and disclose patients protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties
Qualifications
Bilingual in English and Spanish Able to work in the Med-Metrix office or client location on a rotating schedule, Mon-Sat, 8a-5p Experience in Hospital/Facility as well as physician billing required 2-3 years’ experience in insurance collections, including submitting and following up on claims Ability to work well individually and in a team environment. Proficiency with Microsoft Office including Excel and Word Strong organizations, communication and written skills Basic math and typing skills High School Diploma Medical Billing and Coding certification preferred, but not required
Working conditions General office environment; While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear The employee must be able to follow directions, to get along with others, and handle stress; The noise level in the work environment is usually minimal.
