Job Description

Position Summary

Responsible for initiating follow-up to third party payers on delinquent accounts and reviewing insurance correspondence and responding in a timely manner. Responsible for supplying third party payers with appropriate billing information in order to adjudicate a claim. Responsible for assuring appropriate payment received in accordance with contract terms. Performs other duties as assigned.

Essential Functions And Responsibilities Includes The Following

• Understands and adheres to the Performance Standards, Policies and Behaviors (Standard for All Job Descriptions).
• Performs all other related duties as assigned (List last-Standard for all Job Descriptions)
• Completes review of third party outstanding balances and takes appropriate steps to resolve and reconcile outstanding balances
• Reviews correspondence for appropriate action to resolve accounts.
• Researches and initiates refunds to patients or insurance carries as needed.
• Sends inquiries to patients regarding inaccurate or incomplete information.
• Completes charge adjustments and allowances entries on accounts as needed.
• Recodes accounts by insurance carrier and plan number and enters into the HIS for re-billing purposes.
• Processes rejections on third party accounts.
• Reviews on-line billing edits for errors, corrections or missing information. Enter necessary corrections into HIS
• Assists with telephone calls as needed.
• Works with vendors as necessary to reconcile and resolve outstanding accounts.
• Assures payers process claims timely and according to contract provisions.

Education & Experience Requirements

• High School Graduate required
• Clerical Experience Preferred
• Hospital business office experience preferred
• Computer Experience Required

Core Competencies

• Teamwork, Communication skills, problem-solving, adaptability

Physical/Mental Demands/Requirements & Work Environment

• May be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may be exposed to are listed in the hospital’s SDS (Safety Data Sheet) data base and may be accessed through the hospital’s Intranet site (Employee Tools/SDS Access). A copy of the SDS data base can also be found at the hospital switchboard, saved on a disc. (Standard for all Job Descriptions)
• Must be able to remain in stationary position at least 50% of the time
• The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc
• Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine and computer printer
• The person in this position will need to communicate with insurance plans and patients that may have questions. They must be able to accurately exchange information in these situations

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