Collector Governmental - FT - Days - Billing & Collections - DHR Health : Job Details

DHR Health - US:TX:Edinburg - DaysSummary:POSITION SUMMARY:This position is responsible for activities leading to the collection of accounts receivable that are outstanding on the ATB, utilizing verbal and written communications with insurers, providers, employers, and other payers. This position requires being familiar with commercial, workers compensation, and liability third party payer reimbursement, and is accountable for getting those accounts collected. POSITION EDUCATION/ QUALIFICATIONS:

• High school diploma/ GED is required
• Comprehensive knowledge of healthcare reimbursement
• Understands medical terminology
• Knowledge of Microsoft Office suite, working knowledge of Excel required
• Excellent Customer Service
• Good written and verbal communication skills required.
• Must be able to multi-task
• Ability to read, write and speak English.
• Ability to communicate clearly and concisely with all levels of management
• Previous healthcare experience (1-2 yrs.) is required, hospital experience preferred.

JOB KNOWLEDGE/EXPERIENCE:

• Minimum of 1-2 yrs. experience with medical collections, managed care contract experience is preferred.
• Communicates clearly and concisely and is able to work effectively with other employees, patients and external parties
• Provides excellent customer service by establishing and maintaining long-term relationships with carrier reps.
• Demonstrates proficiency in Microsoft Office applications, be able to type at least 35 WPM, and good working knowledge of Excel is required.
• Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly.
• Ability to use the internet to obtain claim status with TMHP, FISS, MY Ability, and Third Party Payers.
• Requires working with minimal to moderate interruptions

Responsibilities:POSITION RESPONSIBILITES:

• Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
• Responsible for following up insurance accounts assigned on AEOS System and or ATB reports
• Contacts insurance carrier for payment on assigned accounts
• Follows-up on an average of 45 (225 weekly) accounts daily and completes 100% of the assigned accounts by the end of each week.
• Adheres to Governmental Billing and Collection payer rules and guidelines located in the Medicare/Medicaid manuals when contacting insurance carrier.
• Proficient in accessing information from AX or Cerner software
• Proficient in accessing the Medicare System-FISS, My Ability for eligibility and claim status and the Medicaid System-TMHP to obtain eligibility and claim status
• Proficient in attempting to update TPR segments as applicable with Third Party Payers
• Proficient in determining when a 121 and or 131 Type of Bill is required for Ancillary billing due to Medical necessity and or Exhausted Benefits; also includes to ensure accounts are sitting with appropriate payment, adjustment and patient balances
• Accurately utilizes AEOS system and or Email, when requesting additional information from within internal

or other departments

• Responsible to send AEOS RQs to Coding as needed for clarification on diagnosis, CPT , HCPCS, or Modifier
• Reviews accounts to ensure the appropriate insurance plan is set-up and the correct insurance adjustment was posted.
• Reads previous notes on the account and document new notes using appropriate mnemonic in the notes tab which is also posted into AEOS
• Familiar with managed care contract terms to determine appropriate reimbursement of insurance carrier
• Ability to compare the payer reimbursement to the expected payment in the computer and question any discrepancies with insurance carrier when on the phone
• Ability to identify accounts that need insurance billing or rebilling i.e., late charges, adjustments, patient related appeals
• Contacts physician's office and request copies of documentation needed
• Request copies of medical records from HIM for any paper records as needed
• Ability to obtain electronic records from the Cerner system as needed
• Contacts patient to ensure all requested information for insurance company is provided. Ex. Pre-existing conditions, COB, accident details, or claim forms, etc
• Daily follow up on faxes or messages to carriers within 24 hours, to ensure the fullest collection effort is accomplished.
• Provide excellent customer service by responding to carriers or patient calls within 24 hours and documents activity on the patient account.
• Assist other collectors in collecting a difficult account as needed
• Select correct adjustment codes and amounts on adjustment letter to appropriately document reason for adjustment
• Notify management team of accounts that denied due to lack of medical necessity, etc, to be assigned nurse auditor for review of possible appeal; all accounts will have appropriate documentation
• Complete adjustment forms appropriately with the correct loss amounts and appropriate adjustment code with necessary backup, variable data to be completed as applicable
• Responsible to complete all tasks assigned daily.
• Follow the Best Business Practice outlined in the DHR Billing Specialist Priority Matrix-See attached.
• Adheres to the QA requirements process.
• Ensures patient confidentiality requirements are met in accordance with HIPAA policies and procedures.
• Other duties as assigned.

Other information:LINES OF REPSONSIBILITES: (Chain-of-command) 1. Manager ? 2. Director ? 3. Chief Revenue Officer CUSTOMER SERVICE: Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including: Commitment, Accountability, Respect, Excellence and Service. AGE SPECIFIC: Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirement relative to his or her age. AMERICANS WITH DISABILITIES ACT: (ADA): A. Essential Duties: Indicated by bold print within performance standards, preceding individual numbered criteria. The following table provides physical requirements that will be associated with, but not limited to, this position: Light/moderate lifting up to 20 lbs, from the floor to shoulder height. Yes Kneeling Yes Must be able to assist other employees with lifting more than 20 lbs. Yes Walking Yes Light/moderate carrying up to 20 lbs. Yes Standing/Squatting Yes Straight pulling Yes Sitting Yes Pulling hand over hand Yes Pushing Yes Repeated bending Yes Stooping/Bending Yes Reaching above shoulder Yes Climbing Stairs Yes Simple grasping Yes Climbing Ladders No Dual simultaneous grasping Yes Depth Perceptions needed Yes Ability to see Yes Identify Colors Yes Operating office equipment Yes Twisting Yes Operating mechanical equipment Yes Crawling No Ability to read and write Yes Ability to Count Yes Ability to hear verbal communication without aid Yes Operating Personal Vehicle Yes Ability to comprehend written/verbal communication Yes Other: Ability to deal with stress Yes OSHA Category III B. Working Conditions: The individual spends over 95% of his/her time in an air-conditioned environment with varying exposures to noise. There is protection from weather conditions but not necessarily from temperature changes. The position does have low exposure to malodorous, infectious body fluids from patients and some minimal exposure to noxious smells from cleansing agents. C. Occupational Exposure: This position has minimal to no exposure to blood, body fluids, or tissues and is an OSHA Category III (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Person who performs these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid or to be potentially exposed in some other way. D. Aptitudes: HIGH 1 2 3 4 5 6 LOW Intelligence: General learning ability: The ability to catch on or understand instructions and underlying principles. Ability to reason and make judgments. 3 Verbal: Ability to understand meanings of words and ideas associated with them, and to use them effectively. To comprehend language, to understand relationships between words, and to understand meanings of whole sentences and paragraphs. To present information or ideas clearly. 3 Numerical: Ability to perform arithmetic operations quickly and accurately. 2 Spatial: Ability to comprehend forms in space and understands relationships of plane and solid objects. Frequently described as the ability to visualize objects or two or three dimensions, or to think visually of geometric forms. 2 Form Perception: Ability to perceive pertinent details and objects or in pictorial or graphic material to make visual comparisons and discriminations and see slight differences in shapes and shadings of figures and widths and lengths of lines. 3 Clerical Perception: Ability to receive pertinent details and verbal or tabular material. To observe differences in copy, to proofread words and numbers, and to avoid perceptual errors in arithmetic computation. 2 Motor Coordination: Ability to coordinate eyes and hands to fingers rapidly and accurately in making precise movements with speed. Ability to make a movement response accurately and quickly. 3 Finger Dexterity: Ability to move hands easily and skillfully. To work with fingers in placing and turning motions. 3 Manual Dexterity: Ability to move hands easily and skillfully. To work with hands in placing and turning motions. 3 Eye-Hand-Foot Coordination: Ability to move the hand and foot coordinately with each other in accordance with visual stimuli. 3 Color Discrimination: Ability to perceive and respond to similarities or differences in colors, shapes, or other values of the same or different color. To identify a particular color, or to recognize harmonious or contrasting color combinations, or to match color adequately. 3 I have read and reviewed my job description with my supervisor or designee and I understand the job I am expected to perform. If applicable ____________ certification will be completed within _________ time frame of hire/transfer date. Employee Signature: Date: Transfer/Hire Date Effective: .