Responsible for obtaining and verifying insurance coverage by interviewing patients, families, and employers and by verifying coverage with insurance companies. Ensure that notifications, authorizations, pre-certifications are made, when appropriate.
Assist self-pay patients in obtaining coverage for hospitalization, e.g., Medical applications, COBRA regulations. Secure promise of payments for patient for all non-covered services.
Ensure that all patients are categorized correctly with regard to financial class, insurance company code, etc. Work with medical areas, e.g., Patient Case Management, physician's offices, to ensure that requested clinical information is supplied timely.
Receive and process information required submitting a third party bill.

Ensure that bills are complete and comprehensive, e.g. correct form for ID numbers, comprehensives of hospital charges, validity of CPT-4, ICD-9, and HCPCS codes. Ensure that billing amounts are correct with regard to case payers, managed care providers with contracts, DRG's day and cost outliners, implantable, exempt services, carve-outs, type of contract, services under NYPHRM, services under HCRA, etc.

Obtain and submit all attachments, as required, such as biopsy reports, ambulance call reports, medical records, CMNs, Tao's.
For electronic claims: maintain up-to-date knowledge with respect to electronic claim submission software and the various payers edits. Review and monitor all billing exception reports for correction/re-submission. Ensure that all claims are submitted in the accepted timeframe.
Review and take appropriate action on account representative's respective portion of trial balance. If a self-pay patient, call patient for further insurance information and /or to secure payment or arrange payment plan.
Resolve all credit balances by requesting refund to patient, insurance company, or make appropriate allowance transaction. Recommend further action, i.e. collection and/or legal after departmental collection policies have been exhausted.
Respond to and investigate all patient inquiries involving financial issues; direct patients to appropriate parties to respond to clinical issues.
Call insurance companies to secure payment.

Take appropriate action upon denial or request for further information. Interface with Medical Records Department/physicians office/clinical area for requested information. Make claims corrections in accordance with compliance policies, payer regulations, and/or legal policies. Review exception reports received from remittance processing area and take appropriate action.

Process all Medicare, Medicaid, and Blue Cross-payments for all participating hospitals through electronic remittance processing software. Post all checks and lockbox remittances manually.
Prepare daily reconciliation of all remittances and checks posted to ensure that all payments and adjustments are done accurately and agree to deposits posted to general ledger.
Review each payment for compliance to rules for carrier; post appropriate allowances. Refer all cases that have been paid incorrectly to the insurance follow-up unit. Make appropriate refund requests when overpayments have been identified.
Ensure that payment posting is kept up-to-date.
If assigned to Emergency Paramedics department, may assist in the research and preparation of statistical reports.
If assigned to Emergency Paramedics department, may monitor entries of 911 call data by dispatchers. Reconcile all dispatch entries with documentation. Investigate, correct, and report discrepancies between data input and documentation. Review documentation for compliance with department policy and report any incidents of non-compliance.
Performs other job related duties as assigned.

Required Criteria High School Diploma or GED Exceptional communication skills - verbal and written Computer and systems competency in the following areas: working knowledge of health systems and interfaces, Microsoft Word, Microsoft Excel, Microsoft Outlook, Microsoft PowerPoint and electronic health records (Epic Preferred) One year related experience

Benefit Conditions:

Only full-time employees eligible

Paid Training:

Yes Typical end time: 9 PM Typical start time: 5 PM Work Remotely Remote (one day in office or for training as needed)

Job Type:

Part-time Pay:

$34.30 - $40.55 per hour

Benefits:

Opportunities for advancement Paid training Work from home People with a criminal record are encouraged to apply

Work Location:

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