Patient Financial Service Coordinator - Reimbursement - FT - Day

stormontvail; Topeka (KS); Presencial; USD 42.000 - 64.000; Jornada completa

Descripción de la vacante

Stormont Vail Health is seeking a healthcare billing specialist to coordinate complex claim submissions with a team handling third-party payors. Responsibilities include submitting accurate claims, addressing denials, and appealing underpayments to maximize cash flow.

The role requires knowledge of third-party billing requirements, strong communication, and the ability to analyze payer policies. A progressive environment emphasizes compliance with HIPAA and regulatory standards.

Formación

• Knowledge of major third-party billing and contract requirements.
• Superior written and oral communication skills.
• Ability to read, analyze and interpret general business material and government regulations.

Responsabilidades

• Generates re-bills after edits are resolved and re-submits claims to third-party payors.
• Identifies and resolves electronic claim edit failures in a timely manner.
• Writes appeals to obtain payment or coordinates with clinical departments to write appeals for medical necessity.
• Notifies management of potential process or system problems causing payer payment errors.
• Collects data and prepares timely reports to monitor compliance and productivity.

Conocimientos

Billing know-how

Attention to detail

Communication skills

Analytical thinking

Educación

High School Diploma / GED

Bachelor's degree in Business / Accounting / Finance

Herramientas

Medical terminology

Descripción del empleo

Position Status: Full time Shift: First Shift (Days - Less than 12 hours per shift) (United States of America) Hours per week: 40

A Brief Overview

The individual in this role is a key member of the financial team by coordinating the billing functions with a group of employees who perform fairly complex claim submission tasks which are completed to ensure: (1) accurate and timely claim submission to the appropriate third party payors; (2) submitted claims are incompliance with federal/state laws and contractual obligations; (3) maximum customer satisfaction; and (4) maximized cash flow. The incumbent is also responsible for identifying claims that fail both internal and external billing edits and taking the appropriate action to reduce the number of claims that fail the billing edits. The individual in this role is responsible for tracking and analyzing payment denials and underpaid claims from all third party payers, appealing denial and under paid claims to obtain payment, coordinating with clinical departments to write appeals regarding medical necessity, and recommending improvements in processes to reduce denials. These activities are completed following established policies and procedures, and in compliance with Joint Commission, Medicare, Payer contracts, HIPAA, regulatory agencies and the organization's Code of Conduct.

Education Qualifications

• High School Diploma / GED Required
• Bachelor's Degree Business, accounting, finance or a related field. Preferred

Experience Qualifications

• 2 years Experience in a clinical healthcare setting such as physician's office or hospital relating to patient financial services, patient registration, patient scheduling or related healthcare. Required

Skills and Abilities

• Knowledge of major third-party billing and contract requirements. (Required proficiency)
• Working knowledge of basic medical terminology. Understanding of medical/clinical treatment processes. (Preferred proficiency)
• Keyboarding skill or typing skill of at least 30 wpm. (Preferred proficiency)
• Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures or government regulations. Superior written and oral communication skills. Ability to effectively present information and respond to questions from management, physicians, employees and the general public.
• Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages. Ability to apply concepts of basic Algebra.
• Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures or government regulations. Superior written and oral communication skills. Ability to effectively present information and respond.

What you will do

• Generates re-bills after all edits have been resolved and re-submits claims to third-party payors. Identifies missing or incorrect requirements of rejected claims and either resolves or forwards promptly to appropriate staff for resolution. Completes manual billing process for claims that cannot be sent electronically.
• Identifies and correctly resolves all electronic claim edit failures in a timely manner. Works with clearinghouse as needed for correction and compliance of clearinghouse edits. Identifies and correctly resolves claims in a timely manner that were generated with inaccurate information.
• Effectively writes appeals to obtain payment or effectively coordinates with clinical departments to write appeals regarding medical necessity. Follows up with third-party payers on appeals in a timely manner until issues is resolved. Effectively writes appeals to obtain payment on underpaid claims.
• Identifies and notifies management of potential process/system problems that cause third-party payer payment errors. Identifies and recommends new programs, computer system updates, computer applications and procedural changes to improve (1) reduce third-party payer denials, (2) customer relations and, (3) efficiency of operations.
• Completes analysis of changes in billing rules, policies and procedures in a timely manner and effectively communicates changes to all appropriate staff.
• Ensures customer concerns are processed in compliance with SVHC policies while maintaining the highest level of patient and employee rights, including confidentiality of patient information and personnel issues.
• Collects data and prepares timely reports to facilitate staff monitoring and maintenance of departmental compliance and productivity standards.
• Reads and comprehends Medicare newsletters from the Medicare Administrative Contractor, correspondence from other third-party payers and monthly trade subscriptions, to keep abreast of new regulations, policies, and payment methodologies.
• Analyzes third-party denials and recommends improvements in processes to reduce denials. Analyzes third-party underpaid claims. Confirms payers' receipt of claims via acknowledgment reports