Sr. Patient Accounts Processor (Req 100918) Position Available In Rensselaer, New York

Job Description:

Description

GENERAL RESPONSIBILITIES

Ensures the financialintegrity and Accounts Receivable by performing establishedfinancial processes that enable and expedite the billing andcollection of medical services.

This includes:

creating claimsaccording to regulations and compliance guidelines, patient accountresearch and resolution, insurance verification and benefitdeterminations, identification of reimbursement issues, resolutionof credits and issuance of refunds, identification of paymentvariance invoices, follow up and resolution of denied claims.

Responsible for working correspondence denials and insurance followup. This must be done in a timely and accurate manner, inaccordance with provided work instructions by performing thefollowing duties. Assists with the training and orientation ofemployees on billing functions.

SPECIFIC RESPONSIBILITIES

Responsible for encounter/claims creation and billing in correctformat as required by payer. Inputs, reviews and updates alldemographic and insurance data as necessary. Process pending claimsas directed by Director and/or Manager of Revenue Cycle.

Responsible for timely submission of claims to the clearing houseand reconciling clearing house reports. Monitor and execute workagainst the assigned Tier(s) and team associated Custom ClaimWorklist(s), relational AR Worklist(s), reporting, projects, orteam / department goals Oversight of HOLD/Tier 1 Worklists andmonitor Missing Slips to ensure timely charge capture Review andadjudication of clearinghouse rejections. Processes third partypayments, denials, and carrier inquiries via receipt of ERA, paper,and any pertinent method. Contacting payers via phone or website,contacting practices, navigating cross-departmentally, writingappeals and facilitating their direction to Athena CBO forsubmission, and all other activities that lead to the successfuladjudication of eligible claims Informs Director of reasons forclaims denials and other changes in claims adjudication includingrecommending claims for write off. Work and resolve unpostables,manage remittance and all correspondence in each of the dashboardsdaily Work and resolve Zero-Pay Worklist, Fully Worked Receivables,complete special project work, review and respond to adjustments /payment data with approval (or initiate appeal) communicate trendsand root issues through proper lines of reporting Receive calls oremails from Patient Financial Specialists with patient’s requestingadvanced assistance with their account Reconciles employees’medical and dental accounts including posting employee payments,applying employee dental discounts based and adjusting non-billableservices/vaccines that are required by WYH for employment purposesand co-pays when appropriate. Develops solutions to claimprocessing and payer adjudication problems. Learn and keep up todate on payer billing requirements, changes in medical/dentalpractices, and coding. Assists with the implementation of any andall process improvement initiatives including developing policiesand procedures. Reviews and transfers patient charges over 120 daysto collection vendor as instructed by Director and/or ManagerRevenue Cycle. Completes patient itemized statements upon request.

Manages/Assists on supplemental claims billing as instructed byDirector and/or Manager Revenue Cycle. Assists in working withother departments to resolve inquiries from staff and/or patients(i.e. accounting, IA’s) Works in a collegial and cooperative mannerwith staff in the department and throughout WYH. Completes allother patient accounts functions and steps not specificallyidentified above but resulting from continuous performanceimprovement activities and periodic training sessions. Participatesin monthly staff meetings and attends monthly payer meetings asrequested by the Director of Revenue Cycle. Provides support toother staff to include additional training, back up, and otherassistance as needed. Learns and keeps up to date on all programsand services offered at WYH Available to work overtime as needed.

Demonstrates excellence in both internal and external customerservice. Tracks weekly production and sends report to DirectorRevenue Cycle for weekly quality and productivity review. Keepmanagement informed of correspondence and communication problemswith service locations Maintains productivity and qualitystandards. Maintain knowledge and understanding of insurancebilling procedures to understand the reason for claims in HOLD,MGRHOLD and

OVERPAID

status to ensure resolution and timely paymentDemonstrates excellence in both internal and external customerservice. Understands and is able to effectively communicate HIPAAcompliance, corporate compliance and client confidentiality.

Ensures and/or remains in compliance with local, state, and federalregulations. Adheres to the National Patient Safety Goals asdefined by the Joint Commission and the Whitney M. Young Jr. HealthCenter. Completes other duties as assigned Requirements

MINIMUMQUALIFICATIONS

The candidate must possess, at a minimum, a highschool diploma or GED and excellent oral and written skills.

Competent in use Microsoft Office applications, especially Excel.

An exceptional ability to make good decisions in accordance withWMY policies and procedures. The candidate should also possess astrong ability to positively function with internal and externalcustomers in a medical billing office setting. Two years experienceas a Medical Biller/Claims Examiner/Claims Analyst demonstratingthe ability to bill using accurate coding and independently resolveclaim problems through to payment. Working knowledge of medicalterminology, CPT4 and ICD coding, and experience with claimsbilling software.

PREFERRED QUALIFICATIONS

Bilingual candidate andexperience with Athena, Denticon or 10E11, billing softwarepreferred. Two years coding experience preferred. All qualifiedapplicants will receive consideration for employment without regardto race, color, religion, sex, sexual orientation, gender identity,national origin, disability, status as a protected veteran, or anyother legally protected status.

Salary range:

$21.87 hourly