Responsible for the duties and services that are of a support nature to the RCBS High Performance Work Teams. Ensures that all processes are performed in a timely and efficient manner. Performs assigned duties such as, cash posting, customer service, data entry and reviewing of claims for proper billing/collections. Responsible for performing billing, collections and reimbursement services of claims and duties to hospitals supported by the RCBS. In doing so, ensures that all claims billed and collected meets all government mandated procedures for Integrity and Compliance. Performs billing, collections and reimbursement services in a prompt and efficient manner. Provides thorough, courteous and professional assistance to patients, physician offices, insurance companies and other clients on an as needed basis while maintaining strictest confidence. Documents, forwards, resolves incoming mail and correspondence. Demonstrates a level of accountability to ensure data and codes are not changed on claims prior to submission if related to diagnosis, charge and/or other clinical type data that RCBS would not have knowledge of. Ensures all Compliance errors are reported to the Director and maintain records and files of documentation supporting bill changes that are directed by Director and/or Integrity Officer. Responsible to ensure successful implementation of Governmental Regulatory Billing changes, including but not limited to Medicare OPPS effective August 1, 2000.
Ensures daily productivity standards are met and daily EOB'S, reports and appeal files are cleared with in 48 hours of receipt (allowing for weekends and holidays).
Log IPOs as issues arise and report during shift briefing
Maintains an active working knowledge of all Governmental Mandated Regulations as it pertains to claims submission. Responsible to perform the necessary research in order to determine proper governmental requirements prior to claims submission.
Responsible to contact Clinical departments and Medical Records in order to obtain information relevant to erred claims as possible Integrity issues. Works with Departments for proper resolution of erred claims. Maintains logs of Integrity related governmental claims and reports to Management weekly.
Reviews and resolves claims that are suspended daily in electronic billing terminals in accordance with procedure.
Responsible for working claims generated reports, providing proper documentation and making necessary corrections within specified times.
Ensures quality standards are met and proper documentation regarding patient accounting records
Reviews and resolves claims that are suspended daily in electronic billing files in accordance with procedure
Ensures all correspondence, rejected claims and returned mail is worked within 48 hours of receipt (allowing for weekends and holidays). Ensures business service requests are worked and documented within 24 hours of receipt.
Identifies and forwards proper account denial information to the designated departmental liaison. Dedicates efforts to ensure a proper denial resolution and timely turnaround.
Monitors and communicates errors generated by other departments, communicating trends
Maintains an active working knowledge of all billing and reimbursement requirements by Payer. Continuously receives updates and information regarding changes and newly revised billing and reimbursement practices and ensures compliance. Stays abreast of all government changes.
Provides continuous updates and information to Business Office Management regarding ongoing errors, payer related issues, registration issues and other controllable QA related activities affecting reimbursement and payment methodology
.Responsible for working all discount applicable generated reports, provide proper documentation of, make necessary corrections within two business days of receipt
Makes appropriate corrections to the hospital lost system tables to ensure system calculated contractuals are accurate. Provides ongoing regular updates and information to Managed Care analyst regarding contracted terms when discounts are calculated inappropriately
Works collaboratively with team members to assist in keeping workload evenly distributed
Ensures quality standards are met in clerical services performed in accordance with Integrity and Compliance guidelines
Review predetermined criteria to process patient and insurance refund request.
Collect balances due from payors
Maintain an active knowledge of all collection requirements by payors
Ensures daily billing and re-bill files are cleared in accordance with documented procedures; daily EOB's, reports, correspondence, and appeal files are cleared within 48 hours of receipt.
Works collector queue daily
Correct claims in RTP status in either CCSM or DDE per Medicare guidelines.
Initiate Medicare Redetermination, Reopening, and/or Reconsideration as needed.
Works correspondence, rejected claim and return mail.
Post HS education preferred
Must have minimum of 2 years' experience with Medicare/Medicaid insurance billing, collections, payment and reimbursement verification and/or refunds.
Understanding of alternative Business Office financial resources and the ability to provide information and/or recommendations related to these sources of recovery are preferred.
General hospital A/R accounts knowledge is required.
College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.
Experience with the Medicare billing process -- what claims can be rebilled online vs doing a redetermination
Understanding of Medicare language
At least five years of experience billing, collecting and validating Medicare payment
Understanding of how and when to bill Medicare as secondary
Understanding of Medicare Dialysis billing
How to read the information in the Common Working File -- HMO coverage, Hospice dates, COB screens etc.
Hand's on experience with Medicare Remote -- DDE
Understanding of and exposure to Medicare Recovery Audit Contractor
Hand's on experience with working Medicare Status Locations (ex: RTP, Denied, Suspense)
Experience with compiling both Redeterminations and Reopening's of Medicare claims
Knowledgeable in locating and referencing CMS and/or Medicare Regulations
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.