Job Summary:

Ensure prompt and efficient handling and filing of insurance claims and related documents in order to receive payment in a timely manner. This is accomplished by following up with insurance companies (government and non-government) as well as identifying and resolving problems. In performance of these duties, this role is responsible for and includes, but is not limited to the following:

• Average quantity and value of accounts worked each day meets standards. Working an account includes filing, re-billing, appealing and working of insurance claims on the hospital accounts receivables.
• Updates to patient accounts notes in the financial software system are documented with appropriate detail. Adjustment request are accurately computed and documented.
• Patient account’s tools are being utilized to enhance and expedite collections.
• Work files used with appropriate work-again dates, action codes, sorts, etc.
• Carrier web sites are being utilized, as well as Medicare DDE.
• Patient account notes reflect the aggressive collection logic necessary for expediting payments from governmental and third-party payors.
• Responsible for processing all assigned bill error claims on a daily basis.
• Responsible for processing assigned bill hold claims on a daily basis. Ensures that the hold claims are at an acceptable level. Communicates with the appropriate departments to ensure data is obtained timely in order to file the claim.
• Ensures there is no excessive and/or unjustified amount of backlogged claims in the work area. Maintains a clear understanding of goals set and strives to meet these goals weekly.
• Able to perform manual intervention of claims such as “split bill”, add room charges, or any other procedure necessary to process an account.
• Responsible for filing all assigned claims requiring special documentation. Each claim must be reviewed, submitted or mailed on a daily basis.
• All other duties as assigned.

Must be able to demonstrate knowledge and skills to appropriately communicate and interact with the patients, families, and visitors of all age groups while being sensitive to their cultural and religious beliefs.

Performance Expectations:

• Initial primary claims available for billing are completed in Epic and available for SSI transmission within 24 hours of being presented to the work queue
• Clear all claim edits available to work by 1pm each work day
• Accesses assigned payor website accounts or links daily to prevent password inactivation
• Notates accounts in Epic fully on each account worked – if it isn’t noted, it wasn’t done
• Maintains follow-up and denial work queues at a level that ensures no accounts are unworked for 15 business days after presenting to the work queue
• Attaches all required supplemental documentation to primary and secondary claims 100% of the time to ensure proper adjudication and prevent claim denials
• Informs Team Lead or Manager of claim edit issues within 24 hours of identifying the problem
• Maintains aged A/R inventory greater than 90 days from bill date at 35% or lower of total A/R
• Maintains Open Denials below $6 million by each Friday’s reporting period
• Achieves monthly Cash Goal as established by management and Administration 60% of the time

Qualifications:

Education/Skills:

High school diploma or equivalent required.

Work Experience:

Insurance follow-up or billing experience in a hospital setting or a physician's office is required. Experience operating a personal computer and calculator accurately is required. Experience with Microsoft Excel required.

Mental Demands:

Numerical ability is required to calculate and check insurance billings. Verbal ability is required to interpret and explain Medicare/Medicaid/Managed Care/Commercial Insurance payment policies and procedures. Must have the ability to communicate effectively.

Work Location:

This position offers both in-office work and telecommuting work from home. Ample workspace will be provided by Forrest General Hospital (FGH) for office work. Appropriate telecommuting work environment includes but is not limited to:

• High speed internet service provided by the employee
• Desktop space to accommodate a laptop, two (2) monitors, keyboard, mouse and paper
• Private area/room without interruption

Acknowledgment of FGH-issued equipment that remains the property of FGH and shall be returned undamaged in the event employment is terminated.