Senior Patient Accounts Processor (Req 100919)

Description

Be a part of the mission at Whitney Young Health (WYH) to provide high quality healthcare that is affordable and accessible to our diverse community.

WYH has a robust benefits package including generous time off, affordable health, dental and vision insurance, 401k with safe harbor employer match, tuition reimbursement, term life insurance, commuter benefits and more!

GENERAL RESPONSIBILITIES: Ensures the financial integrity and Accounts Receivable by performing established financial processes that enable and expedite the billing and collection of medical services. This includes: creating claims according to regulations and compliance guidelines, patient account research and resolution, insurance verification and benefit determinations, identification of reimbursement issues, resolution of credits and issuance of refunds, identification of payment variance invoices, follow up and resolution of denied claims. Responsible for working correspondence denials and insurance follow up. This must be done in a timely and accurate manner, in accordance with provided work instructions by performing the following duties. Assists with the training and orientation of employees on billing functions.

SPECIFIC RESPONSIBILITIES:

• Responsible for encounter/claims creation and billing in correct format as required by payer.
• Inputs, reviews and updates all demographic and insurance data as necessary.
• Process pending claims as directed by Director and/or Manager of Revenue Cycle.
• Responsible for timely submission of claims to the clearing house and reconciling clearing house reports.
• Monitor and execute work against the assigned Tier(s) and team associated Custom Claim Worklist(s), relational AR Worklist(s), reporting, projects, or team / department goals
• Oversight of HOLD/Tier 1 Worklists and monitor Missing Slips to ensure timely charge capture
• Review and adjudication of clearinghouse rejections.
• Processes third party payments, denials, and carrier inquiries via receipt of ERA, paper, and any pertinent method.
• Contacting payers via phone or website, contacting practices, navigating cross-departmentally, writing appeals and facilitating their direction to Athena CBO for submission, and all other activities that lead to the successful adjudication of eligible claims
• Informs Director of reasons for claims denials and other changes in claims adjudication including recommending claims for write off.
• Work and resolve unpostables, manage remittance and all correspondence in each of the dashboards daily
• 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 trends and root issues through proper lines of reporting
• Receive calls or emails from Patient Financial Specialists with patient’s requesting advanced assistance with their account
• Reconciles employees’ medical and dental accounts including posting employee payments, applying employee dental discounts based and adjusting non-billable services/vaccines that are required by WYH for employment purposes and co-pays when appropriate.
• Develops solutions to claim processing and payer adjudication problems.
• Learn and keep up to date on payer billing requirements, changes in medical/dental practices, and coding.
• Assists with the implementation of any and all process improvement initiatives including developing policies and procedures.
• Reviews and transfers patient charges over 120 days to collection vendor as instructed by Director and/or Manager Revenue Cycle.
• Completes patient itemized statements upon request.
• Manages/Assists on supplemental claims billing as instructed by Director and/or Manager Revenue Cycle.
• Assists in working with other departments to resolve inquiries from staff and/or patients (i.e. accounting, IA’s)
• Works in a collegial and cooperative manner with staff in the department and throughout WYH.
• Completes all other patient accounts functions and steps not specifically identified above but resulting from continuous performance improvement activities and periodic training sessions.
• Participates in monthly staff meetings and attends monthly payer meetings as requested by the Director of Revenue Cycle.
• Provides support to other staff to include additional training, back up, and other assistance as needed.
• Learns and keeps up to date on all programs and services offered at WYH
• Available to work overtime as needed.
• Demonstrates excellence in both internal and external customer service.
• Tracks weekly production and sends report to Director Revenue Cycle for weekly quality and productivity review.
• Keep management informed of correspondence and communication problems with service locations
• Maintains productivity and quality standards.
• Maintain knowledge and understanding of insurance billing procedures to understand the reason for claims in HOLD, MGRHOLD and OVERPAID status to ensure resolution and timely payment
• Demonstrates excellence in both internal and external customer service.
• Understands and is able to effectively communicate HIPAA compliance, corporate compliance and client confidentiality.
• Ensures and/or remains in compliance with local, state, and federal regulations.
• Adheres to the National Patient Safety Goals as defined by the Joint Commission and the Whitney M. Young Jr. Health Center.
• Completes other duties as assigned

Requirements

MINIMUM QUALIFICATIONS:

The candidate must possess, at a minimum, a high school 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 with WMY policies and procedures. The candidate should also possess a strong ability to positively function with internal and external customers in a medical billing office setting. Two years experience as a Medical Biller/Claims Examiner/Claims Analyst demonstrating the ability to bill using accurate coding and independently resolve claim problems through to payment. Working knowledge of medical terminology, CPT4 and ICD coding, and experience with claims billing software.

PREFERRED QUALIFICATIONS:

Bilingual candidate and experience with Athena, Denticon or 10E11, billing software preferred. Two years coding experience preferred.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other legally protected status.

Salary range: $21.87 hourly