Duties and Responsibilities:
- File all charge, payment and adjustment batches in the appropriate format by batch date for quick reference.
- Provide customer service both on the telephone and in the office for patients and authorized representatives regarding patient accounts. Patient calls regarding accounts receivable should be returned within 2 business days to ensure maximum patient satisfaction.
- Verify demographic and insurance information as needed to insure accuracy. Update the practice management system as required.
- Follow-up on outstanding insurance claims at 31-days from the date of submission.
- Follow-up on all returned claims, correspondence, denials, account reconciliations and rebills within five working days of receipt to achieve maximum reimbursement in a timely manner with an emphasis on patient satisfaction.
- Provide information pertaining to billing, coding, managed care networks, insurance carriers and reimbursement to physicians, managers and coworkers.
- Submit primary and secondary insurance claims electronically and on HCFA forms on a regular basis to ensure timely reimbursement.
- Monitor reimbursement from managed care networks and insurance carriers to ensure reimbursement is consistent with current contracted rates.
- Utilize and become proficient using provider portals for eligibility verification and claim status and to efficiently conduct accounts receivable follow-up.
- Maintain information regarding coding, insurance carriers, managed care networks in an organized easy to reference format.
- Adhere to write-off policies, refund policies and other accounts receivable policies as outlined in the Procedure Manual.
- Other duties as assigned.
Organizational Duties and Responsibilities:
- Become proficient with the clinic’s electronic medical records system
- Maintain compliance with federal and state regulations such as HIPAA, Privacy & Security, and Infection Control)
- Follows all GPWHC Employee Handbook and policies and procedures
- Respect and promote patient rights
- Demonstrate a cooperative work attitude and show respect toward physicians, coworkers, management, patients, visitors and sales representatives.
- Identify ways to improve practice operations.
- Combination of sitting, standing, bending, light lifting and walking.
- Requires a full range of body motion including manual and finger dexterity and hand-eye coordination.
- Requires corrected vision and hearing to a normal range.
- Requires the ability to manage stressful situations.
- Occasional stress from varying demands.
- Is susceptible to communicable disease transmitted by patients and co-workers
Knowledge and Skills:
- Requires a comprehensive understanding of accounts receivable management in a healthcare setting.
- Working knowledge of managed care plans, insurance carriers, referrals and pre-certification procedures.
- A strong working knowledge of CPT, ICD-10, HCPCS, modifiers, coding and documentation guidelines is encouraged.
- Strong customer service, organizational and communication skills are essential.
- Ability to prioritize multiple tasks simultaneously in an occasionally stressful environment.
- Strong computer and typing skills and a working knowledge of Medicare Compliance
- Accurate and precise attention to detail
- High School Diploma or GED certificate is required; Bachelors’ degree in related field preferred
- Two years of accounts receivable experience in an obstetrics and/or gynecology setting is preferred.
- CPC Certification or Equivalent is preferred
- Understanding of medical terminology, anatomy and physiology