Responsible for performing research and follow up activities on assigned accounts in order to obtain additional reimbursement for Praxis Healthcare Solutions, LLC. Clients.
Duties and Responsibilities (including but not limited to)
- Ensure accurate and complete account follow-up by demonstrating a thorough understanding of carrier-specific reimbursement as applicable to claim processing to include: eligibility discrepancies, UB04 claims form preparation, DRG, per diem, case rate reimbursements, etc.
- Conduct appropriate activity on accounts by contacting government agencies, third-party payors, and patients/guarantors via phone, e-mail, or online. Continue reimbursement activity until account resolved.
- Document all follow-up activity taken on an account in the patient account notes
- Resolve claim processing issues on a timely basis by reviewing claim inventories, payments, and adjustments daily
- Responsible for maintaining control of assigned inventory and ensure that daily productivity standards of accounts are met
- Taking appropriate actions to ensure payments and adjustments have been posted properly as well as identify applicable accounts for secondary billing and follow-up
- Research and document any correspondence received related to assigned accounts
- Assess accounts for balance accuracy, confirm correct payor billed, coding accuracy, denials, and outstanding insurance requests
- Provide documentation appropriately and submit corrections; or if payor error, escalate for re- processing in a professional and timely manner
- Request additional information from patients and payors as needed
- Review payor contracts to determine expected reimbursement from claims, identify underpayments, and draft payor demand letters
- Identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed
- Identify payor issues and trends, and escalate those issues to Management
- Ensure compliance with State and Federal Law Regulations for Managed Care and other Third Party Payors
KNOWLEDGE, SKILLS, ABILITIES
- Must be able to communicate effectively and professionally with strong attention to details and problem solving both verbally and written. Specifically, strong telephone communications skills are required.
- Ability to prioritize work and meet deadlines is required
- Knowledge of general office procedures is required
- Ability to operate common computer systems, utilize hospital patient accounting system and business software is required
- Intermediate understanding of ICD-9, HCPCS/CPT coding and medical terminology, understanding of ICD-10 a plus
- Strong proficiency in Microsoft Office (Word, Excel) skills
- Advanced business letter writing skills to include correct use of grammar and punctuation
- Understanding of the revenue cycle process
- Strong interpersonal skills
- Above average analytical and critical thinking skills
- Ability to make sound decisions
- Has a full understanding of hospital reimbursement, Intermediate knowledge of Managed Care contracts, Contract Language and Federal and State requirements.
- Familiar with terms such as HMO, PPO, IPA, capitation and how these payors process claims
- Intermediate understanding of EOB, hospital billing form requirements (UB04) and familiar with the HCFA 1500 form
- High School Graduate minimum education requirement
- Some college coursework in business administration or accounting strongly preferred
- 2-3 years medical claims and/or hospital claims experience required
Job Type: Full Time – days