SCOPE / GENERAL PURPOSE OF JOB:
Responsible for timely daily Accounts Receivable resolution in accordance with RC Billing standards and Reimbursement policy and procedures. Is responsible for seeking resolution to problems payers while ensuring excellent communication between the Central Business Office management and ensuring client satisfaction. Responsible for generating revenue by researching outstanding payer claims and patient balances, generates appeals, makes payment arrangements; collects on accounts; monitors and pursues delinquent accounts.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
· Demonstrates thorough understanding of the Accounts Receivable function compliant with Federal and State regulations and RC Billing policy and procedures.
· Works Insurance Accounts Receivable reports per Accounts Receivable work plan beginning with >120 aging top dollar working in descending order.
· Submits written appeals to insurance carriers when applicable and ensures timely follow-up regarding status.
· Maintains tickler file and ensures timely follow-up of outstanding claims/balances
· Daily Prepares and maintains the Client Communication Log per client ensuring timely resolution.
· Maintains working day to day knowledge of the practice management system. (Misys/Tiger, Allscripts, Allscripts Pro PM and Practice EDI Insight).
· Maintains strong working knowledge of Radiation Oncology coding or the specific specialty in which the Accounts Receivable is assigned.
· Updates job knowledge by participating in educational opportunities. (Misys & Rad Onc Coding)
· Ensures strong communication with Central Business Office management team.
· Ensures compliance with RC Billing Reimbursement Policies and Procedures to maximize efficiency. Ensures compliance with appropriate industry regulations and State and Federal regulations.
· Maintains working knowledge of applicable laws and regulations as they relate to assigned responsibilities.
· Maintains confidentially of all information related to patients, medical staff, finances and cost effective health care delivery issues.
· Strives to achieve and maintain company Days Sales Outstanding and Account Receivable aging standards.
· Strives to achieve Central Business Office goals and benchmarks.
· Demonstrates the ability to work well with peers while ensuring a strong cohesive team.
· Additional duties as assigned.
EDUCATION AND/OR EXPERIENCE:
· High school diploma or equivalent.
· Two (2) to four (4) years applicable medical Central Business Office experience required.
· Knowledge of organization policies and procedures both final and draft or as assigned.
· Knowledge of business office procedures.
· Knowledge of insurance agency operating procedures and practices.
· Skill in exercising initiative, judgment, discretion, decision making and organizational skills to achieve business unit objectives.
· Skill in identifying and resolving problems
· Ability to communicate effectively and professionally.
· Ability to establish and maintain effective professional working relationships with all employees and clients.
· Knowledge of CPT-4 and ICD-10 coding.
· Knowledge of Allscripts, Misys/Tiger, Allscripts Pro PM and Practice EDI Insight preferred.
· Ability to communicate effectively orally and in writing.
CERTIFICATIONS / LICENSURES / CREDENTIALS: None
SUPERVISORY RESPONSIBILITIES: None
The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position requires full range of body motion including manual and finger dexterity and eye-hand coordination. The position additionally requires standing/sitting for extensive periods of time. Occasional lifting and carrying items weighing up to forty (40) pounds may be required. Requires corrected vision and hearing to normal range.
WORK ENVIRONMENT:The work environment characteristics described are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in an office environment involving frequent interaction with staff, clients and the general public.