Business Office Specialists (Billing Specialist)-RMF Revenue Cycle
Company: DHR Health
Location: Mcallen
Posted on: May 22, 2023
Job Description:
Description
Position at DHR Health
POSITION SUMMARY:
This position is responsible for business office activities which
include collection of accounts receivable, patient billing,
customer service, cashiering, refunds/recoupment's, appeals, and
provides refunds for services to patients and third party payers as
needed. This position requires that at least three (3) of the
functions above are able to be performed.
POSITION EDUCATION/QUALIFICATIONS:
- High School Diploma/GED is required
- Comprehensive knowledge of healthcare reimbursement.
- Understands medical terminology
- Familiarity with EOB's and RA's
- Knowledge of Microsoft Office suite, working knowledge of Excel
required.
- Excellent Customer Service
- Good written and verbal communication skills required
- Must be able to multi-task
- Ability to read, write and speak English
- Ability to communicate clearly and concisely with all levels of
management
- Bilingual - English/Spanish, preferred
JOB KNOWLEDGE/EXPERIENCE:
- Previous healthcare experience (2-3 yrs.) required, hospital
experience preferred.
- Communicates clearly and concisely and is able to work
effectively with other employees, patients and external
parties
- Establishes and maintains long-term customer relationships,
building rapport with other department staff
- Demonstrates proficiency in Microsoft Office applications, be
able to type at least 35 WPM, and good working knowledge of Excel
is required.
- Able to perform basic mathematical calculations, balance and
reconcile figures, punctuate properly and spell correctly.
- Medical Terminology, ICD-9, ICD - 10, Codes, CPT Codes, HCPCS
code, Modifier knowledge required.
- Ability to use the internet to obtain information from Third
Party Payers or other sources is required.
- Requires working with minimal to moderate interruptions
POSITION RESPONSIBILITIES:
- Promotes the facility mission, vision and values by effectively
communicating them to others. Considers mission, vision and values
in developing services, standards and practices
- Receives incoming and outgoing calls from patients and informs
them of their balance due after insurance has paid.
- Assists patients and carriers with questions and concerns
regarding the billing and collections of accounts.
- Obtains copies of required insurance identification cards, as
needed.
- Works special projects as assigned.
- Assist with posting payments and identifying correct
I-plan
- Daily download and review report of patient balance for
statement release.
- Update address on return mail as needed
- Review RAs and EOB's total charges, amount of insurance payment
and balance owed by patient or responsible party.
- Explains hospital payment policies and collects patient balance
due and writes receipts for all payments collected.
- Performs daily reconciliation of petty cash.
- Download and post electronic remits and apply payments and
adjustments as per I-plan.
- Make deposits to the bank.
- Researches credit balances for accurate processing of refunds
due to over payments and/or allowances requiring a correction in a
timely manner.
- Prepares credit worksheet and processes all transactions
required to request refund checks or to correct account
balances.
- Transfers patient credit balances to outstanding accounts
according to hospital policy and procedure, and prepares letters of
explanation concerning refund issued to third party payers and
patients.
- Researches and prepares quarterly Medicare credit report.
- Responds to all mail and phone calls concerning credit balances
and refunds checks.
- Completes provider applications for payers
- Follows-up accounts on assigned ATB and/or custom reports and
contacts insurance carrier for payment and/or recoupment's.
- Enter appropriate mnemonic in the notes tab
- Utilizes tickler, when requesting additional information from
other co-workers or departments
- Responds to correspondence from insurance carriers in a timely
manner.
- Determines financial status and refers patient for financial
screening as appropriate
- Ability to identify accounts that need insurance billing or
rebilling
- Adheres to collection tips booklet when contacting insurance
carrier.
- Demonstrates proficiency in billing and follow up of Medicare,
Medicaid claims on-line or through billing software
- Proficient in accessing information needed from Cerner and AX
document imaging software.
- Request copies of medical records from HIM for any paper
records
- Ability to access medical records from Cerner system to appeal
claims with carriers.
- Enter and maintain appealed accounts through the variable data
system.
- Maintain PMMC software system for carrier over and under
payments to facility.
- Create appeal letters with appropriate details of appeal
- Select correct adjustment codes on adjustment form to
appropriately document reason for adjustment
- Complete adjustment form appropriately with the correct dollar
amount assigned to the adjustment code
- Ensures patient confidentiality requirements are met in
accordance with HIPAA policies and procedures.
- Other duties as assigned.
Keywords: DHR Health, McAllen , Business Office Specialists (Billing Specialist)-RMF Revenue Cycle, Accounting, Auditing , Mcallen, Texas
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