Description

Job Summary

This individual processes and applies all manual and electronic payments received from insurance companies and patient payments for the Hospital and Physician billing systems. The application of an insurance payment is applied with the appropriate contractual discount based on the managed care or government reimbursement agreements. Accuracy for this individual must reside at the highest level ensuring that all payments and contractual discounts are applied to the appropriate charge or charges. This individual must have the ability to read and interpret explanation of benefits in order to determine and apply appropriate ANSI codes with each payment or denial that best describes the reason for payment or denial. This individual investigates and resolves all self-pay credits within the Hospital and physician billing systems; reviewing guarantor family accounts for open balances to transfer money or processing to refund the credit directly back to the guarantor. This individual is also responsible for reconciling incoming money from all Physician offices.

Job Responsibilities

Process Payments to accurate charges through both manual entry and electronic remittance advices (ERAs).

Process no payment EOBs i.e. deductibles or non-covered services.

Applies contractual discounts in accordance with managed care agreements.

Reconciles daily batch postings.

Understands and interprets EOBs ensuring accurate applications to date(s) of service.

Applies valid ANSI Remit/Reason code(s) to each entry.

Applies self pay payments received from ALL practice locations.

Processes and applies >95% of ALL department adjustments.

Loads appropriate insurance mnemonic to accounts when payment is received and insurance is not loaded.

Assists physician offices with balancing issues; walking individual through corrections on Patient Receipt Database.

Analyzes and corrects ERA errors by manually reviewing EOB and applying payment or adjustment accordingly.

Provides back-up coverage for peer co-workers to cover illnesses or vacations to ensure the daily completion of tasks are being met.

Assists in training new employees as required.

Assists with other projects as assigned by supervisor.

Investigates and resolves all patient overpayments.

Maintains and monitors credits through Business Intelligence Platform, Merlin.

Reconciles payments received from physician offices.

Qualifications

Requirements

Education: High School Diploma or Equivalent

Required Experience: 1-2 years’ experience

Populations Served:

While performing this job, the employee may care for patients in the following age groups.

• Young Adult: 17 to < 30 years

• Middle Adult: 30 to < 60 years

• Older Adult: > 60 years

• Serves patients in areas other than patient care.

• No responsibility to treat or care for patients.

While performing this job, the employee does not care for patients in the following age groups.

    • Adolescent: 13 to < 17 years

• Neonate: < 30 days

• Infant: < 1 year

• Early Childhood: 1 year and < 5 years

• Late Childhood: 5 years and < 13 years