Review and process accounts with insurance carriers as required, verify information and make appropriate transactions to the accounts in the computer system. Reviews each payment to determine if the account was paid according to contract obligation and if not takes the necessary action to appeal and obtain correct payment.
Determines collection course of action for all applicable accounts including up to resubmitting claims for payment, correspondence with insurance carriers and patients (verbally and written), maintaining accurate records of documentation of action for the account and transaction, and developing and requesting needed appeals to insurance carriers. Also to escalate the problem accounts according to the guidelines of the department.
The primary job functions of this position should be accomplished working to the achieve the goal of supporting the vision of Huntsville Hospital by ensuring all clinical services provided by the organization are appropriately compensated by third party payors, patients, or charity programs. Overall goal achieved by continuously striving to ensure:
- Regulatory and payor compliance of patient access, charging, billing, and collection standards
- Patient satisfaction of patient access, billing, and follow-up processes
- Positive communications and outcomes with internal customers and support services
- Effective utilization of outsourced and internal resources
- Staff development
- Updated and applied accurate policy and procedures
- Active quality assurance and process improvement
- Accurate application of payor contracts
Minimum Knowledge, Skills and Experience required:
- General application knowledge of EXCEL, WORD, and ACCESS.
- Proven applicable experience working in an environment that utilizes electronic billing, internal report archives, and tools for applicable database management strongly preferred.
- 1 to 2 years work experience of Hospital or Physician office billing and collection processes including producing account appeals with positive outcomes specifically for work compensation accounts strongly preferred.
- Proven applicable experience of preparing complex correspondence to resolve accounts strongly preferred.
- Effective communication skills verbally and written with internal Hospital departments, Physician Offices, Patient, and Insurance payors.
- Must be able to effectively manage a large volume of accounts while maintaining a high accuracy and positive outcomes.
- High school diploma or GED
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