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Managed Medicare Collector
-Performs Medical collection functions relevant to the Patient Financial Services Department in a manner that meets or exceeds CHRISTUS Health key performance criteria as it relates to cash collections, aged accounts receivables and denials.
-Contact will be made with payers through written correspondence, on-line inquiries or phone to obtain claim status, clarification or to escalate resolution of patient accounts. Exhibits excellent verbal and written communication skills.
- Responsible for researching and resolving accounts. Review proper account handling from admission through self pay collections and applies corrective actions as necessary.
-Understanding of insurance denials and underpayments and routes account to proper department for assistance in resolution. Exhibits excellent problem solving skills.
-Reviews account payment for accuracy utilizing an insurance explanation of benefits, on-line resources or contracts. Determines if balance should be moved to the next responsibility party. Able to resolve credit balances by determining if an account is overpaid or over adjusted.
-Ensures proper reimbursement for all services. All appeals and/or refunds are filed timely in accordance with payer regulations or contracts.
-Responsible to contact CHRISTUS Health facility departments in order to resolve outstanding questions related to account or charge posting information to ensure account integrity and compliance with payer and/or government regulations and to ensure timeliness of follow-up activities.
-Performs rebilling functions as appropriate and exhibits knowledge of UB04 and 1500 bill forms and filing requirements. Exhibits an understanding of CPT, HCPCS and ICD-10 coding regulations and guidelines.
-Understands state insurance laws and the various appeals processes including but not limited to Insurance Commission filings.
-Ensures quality and productivity standards are met. Appropriately documents patient accounting host system or other systems utilized by Patient Financial Services in accordance with policy and procedures.
- Provides continuous updates and information to Patient Financial Services Leadership Team regarding ongoing errors, payer related issues/trends, registration and other controllable QA related activities affecting productivity, reimbursement and/or payment delays.
- Maintains thorough and detailed knowledge of state and federal collection laws, third-party payer claims processing and appeal procedures as well as the different payment methodologies. Ensures compliance with state and federal laws regarding all cash collections activities.
-Functions as a subject matter expert in assisting facility and other Patient Financial Service associates with account and payer related questions.
- Functions effectively within a team and participates and contributes constructively to produce results in a cooperative effort.
-Continually seeks to understand and act upon customer needs, concerns, and priorities. Meets customer expectations and requirements, and gains customer trust and respect.
- Demonstrates ongoing enthusiasm and commitment to the work assigned.
-Works with Supervisor to receive feedback on performance and create a personal development plan.
HS Diploma or equivalency required
Post HS education preferred
Minimum of two years of experience and excellent working knowledge of insurance carriers' billing regulations and requirements including claims submission, claims follow-up, appeals process, and focused review processes required.
Experience calculating expected reimbursement according to payer regulations and/or contracts
Demonstrated success working in a team environment focused on meeting organization goals and objectives required.
General hospital A/R accounts knowledge is required.
College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.
Understanding of alternativeBusiness Office financial resources and the ability to provide information and/or recommendations related to these sources of recovery are preferred.
In 1999, two historic Catholic charities became one, forming CHRISTUS Health and creating a unique purpose in the modern health care market - to take better care of people.
To extend the healing ministry of Jesus Christ, the mission that the Sisters of Charity Health Care system and Incarnate Word Health system shared for more than a century, is now also the mission of CHRISTUS Health.
Ranked among the top 10 Catholic health systems in the United States by size, the CHRISTUS Health system includes more than 40 hospitals and facilities in seven U.S. states, Chile and six states in Mexico, with assets of more than $4.6 billion.
Whether seeking care in Alexandria Louisiana, or Coahuila, Mexico, patients discover that the healing spirit is alive at CHRISTUS Health.