Job Description

Job Description

Performs collection follow-up on insurance outstanding balances; identification of claim problems and resolution; standards within compliance of government and managed care contract terms.

POSITION PURPOSE

Performs collection follow-up on insurance outstanding balances; identification of claim problems and resolution; standards within compliance of government and managed care contract terms.

ESSENTIAL JOB FUNCTIONS:

* Performs follow-up on outstanding insurance balances within required time frame. Obtains confirmation of payment or required documentation.
* Documents all actions taken on appropriate systems so that is clearly communicated process for resolution.
* Makes appropriate number of calls based on assigned payer.
* Handles and resolves incoming correspondence within 5 days of receipt and updates system
* Initiates appropriate review and supporting documentation for denials within payer specific guidelines.
* Professionally handles all incoming calls from customers including returning the calls and expediting requests in a timely manner.
* Displays competency in health care billing requirement/follow up. Maintains current knowledge regarding assigned/related area by keeping up to date on communication, newsletters and resource information within department.
* Accepts responsibility, maintains confidentiality and performs routine assignments independently.
* Must be a team player and able to work with a very dynamic team and a lot of change.
* Conforms to department dress code policy and wears ID badge. Adheres to scheduled work hours, attendance/tardiness policy. Demonstrates proficiency at hospital wide and/or department specific computer software and technology. Displays competency in the use of department equipment, all computer software, fax, telephones and copy machine.

EDUCATION, SKILLS & EXPERIENCE:

* Education:

High School graduate or equivalent

* Experience:

Specialist I:

* Must have six (6) months experience in a hospital or medical facility setting, OR have taken a minimum of one college or certificate program course that would provide basic understanding of billing and coding.
* Medicare knowledge is a plus

* Administrative Skills:
* Excellent interpersonal skills required to communicate with direct staff and internal/external customers.
* Must possess excellent time management and organizational skills.
* Demonstrated critical thinking, creativity, problem solving and decision-making skills.