Patient Financial Specialist - Financial Services

Description

Summary :

Responsible for the duties and services that are of asupport nature to the RCBS High Performance Work Teams. Ensuresthat all processes are performed in a timely and efficient manner.

Performs assigned duties such as, cash posting, customer service,data entry and reviewing of claims for proper billing / collections.

Responsible for performing billing, collections and reimbursementservices of claims and duties to hospitals supported by the RCBS.

In doing so, ensures that all claims billed and collected meets allgovernment mandated procedures for Integrity and Compliance.

Performs billing, collections and reimbursement services in aprompt and efficient manner. Provides thorough, courteous andprofessional assistance to patients, physician offices, insurancecompanies and other clients on an as needed basis while maintainingstrictest confidence.

Documents, forwards, resolves incoming mailand correspondence. Demonstrates a level of accountability toensure data and codes are not changed on claims prior to submissionif related to diagnosis, charge and / or other clinical type datathat RCBS would not have knowledge of.

Ensures all Complianceerrors are reported to the Director and maintain records and filesof documentation supporting bill changes that are directed byDirector and / or Integrity Officer.

Responsible to ensure successfulimplementation of Governmental Regulatory Billing changes,including but not limited to Medicare OPPS effective August 1,2000.

Responsibilities :

• Ensures daily productivity standards are metand daily EOB'S, reports and appeal files are cleared with in 48hours of receipt (allowing for weekends andholidays)
• Log IPOs as issues arise and reportduring shift briefing Maintains an active working knowledge of allGovernmental Mandated Regulations as it pertains to claimssubmission
• Responsible to perform the necessaryresearch in order to determine proper governmental requirementsprior to claims submission
• Responsible tocontact Clinical departments and Medical Records in order to obtaininformation relevant to erred claims as possible Integrityissues
• Works with Departments for properresolution of erred claims
• Maintains logs ofIntegrity related governmental claims and reports to Managementweekly
• Reviews and resolves claims that aresuspended daily in electronic billing terminals in accordance withprocedure
• Responsible for working claimsgenerated reports, providing proper documentation and makingnecessary corrections within specifiedtimes
• Ensures quality standards are met andproper documentation regarding patient accounting records Reviewsand resolves claims that are suspended daily in electronic billingfiles in accordance with procedure Ensures all correspondence,rejected claims and returned mail is worked within 48 hours ofreceipt (allowing for weekends andholidays)
• Ensures business service requests areworked and documented within 24 hours ofreceipt
• Identifies and forwards proper accountdenial information to the designated departmentalliaison
• Dedicates efforts to ensure a properdenial resolution and timelyturnaround
• Monitors and communicates errorsgenerated by other departments, communicating trends Maintains anactive working knowledge of all billing and reimbursementrequirements by Payer
• Continuously receivesupdates and information regarding changes and newly revised billingand reimbursement practices and ensurescompliance
• Stays abreast of all governmentchanges
• Provides continuous updates andinformation to Business Office Management regarding ongoing errors,payer related issues, registration issues and other controllable QArelated activities affecting reimbursement and paymentmethodology

Work Type : Full Time

Full Time

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