Follow Up Representative - Catholic Health Service : Job Details

Overview:

Catholic Health is one of Long Islands finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island.

At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes to every patient, every time.

We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace!

Under the direction of the Hospital RRC Manager, the RRC Follow-Up Representative is responsible to review all assigned third-party and/ or patient accounts, ensure that responsible payers are billed and remit payment in a timely manner, and to document account status and actions appropriately in the patient accounting system(s). Identifies and communicates complex claim issues, billing/ payment trends, and recommended solutions to leadership.

DUTIES/RESPONSIBILITIES

• Reviews aged trial balances and work-queues to determine accounts requiring action. In accordance with department policies and procedures, performs such actions as initiating phone calls and website inquiries, drafting and submitting letters/ appeals, attending payer meetings in order to move accounts forward in the follow up and payment cycle.
• Assesses payments and adjustments for accuracy and timeliness. Interprets Managed Care/ contracts to establish accuracy the A/R. Reviews regulatory updates to understand impacts to reimbursement from federal and state payers. Corrects transactions as necessary in addition to reporting and documenting on-going issues to management.

• Determines the reason for a denial and follows-up / appeals accordingly. Investigates under / over payments and takes appropriate actions to resolve the account in accordance with departmental procedures

• Transfers balances to next responsible parties as appropriate
• Ensures claims meet payer requirements and are compliant; resolves claim and billing errors as necessary. Submits and resubmits claims electronically or by paper as necessary
• Ensures claims are crossed over to secondary and tertiary payers and reports any delays in unbilled claims
• Responsible for meeting and/ or exceeding productivity and quality standards as set forth in the departments policies and procedures.

• Is aware of timely filing guidelines for all payers; prioritizes work based on these timelines to ensure claims are being followed up accordingly and financial losses are minimized
• Performs root cause analysis with a solutions focus; tracks trends and escalates carrier or revenue cycle system issues to Manager
• Participates in audits as directed by leadership; collects and assembles financial documents related to billing and payment to substantiate services and reimbursement
• Runs and works reports as directed by the Manager for resolution of A/R, claims, and projects
• Regularly meets with Manager to discuss and resolve reimbursement issues and billing obstacles
• Performs other duties as assigned

POSITION REQUIREMENTS AND QUALIFICATIONS:

Education and Experience Minimum:

High School diploma or equivalent required plus one year of hospital billing experience, including third party follow-up and customer service related duties.

Education and Experience Preferred:

Associates degree with a minimum of two years

Under the direction of the Hospital RRC Manager, the RRC Follow-Up Representative is responsible to review all assigned third-party and/ or patient accounts, ensure that responsible payers are billed and remit payment in a timely manner, and to document account status and actions appropriately in the patient accounting system(s). Identifies and communicates complex claim issues, billing/ payment trends, and recommended solutions to leadership.

DUTIES/RESPONSIBILITIES

• Reviews aged trial balances and work-queues to determine accounts requiring action. In accordance with department policies and procedures, performs such actions as initiating phone calls and website inquiries, drafting and submitting letters/ appeals, attending payer meetings in order to move accounts forward in the follow up and payment cycle.
• Assesses payments and adjustments for accuracy and timeliness. Interprets Managed Care/ contracts to establish accuracy the A/R. Reviews regulatory updates to understand impacts to reimbursement from federal and state payers. Corrects transactions as necessary in addition to reporting and documenting on-going issues to management.

• Determines the reason for a denial and follows-up / appeals accordingly. Investigates under / over payments and takes appropriate actions to resolve the account in accordance with departmental procedures

• Transfers balances to next responsible parties as appropriate
• Ensures claims meet payer requirements and are compliant; resolves claim and billing errors as necessary. Submits and resubmits claims electronically or by paper as necessary.
• Ensures claims are crossed over to secondary and tertiary payers and reports any delays in unbilled claims
• Responsible for meeting and/ or exceeding productivity and quality standards as set forth in the departments policies and procedures.

• Is aware of timely filing guidelines for all payers; prioritizes work based on these timelines to ensure claims are being followed up accordingly and financial losses are minimized
• Performs root cause analysis with a solutions focus; tracks trends and escalates carrier or revenue cycle system issues to Manager
• Participates in audits as directed by leadership; collects and assembles financial documents related to billing and payment to substantiate services and reimbursement
• Runs and works reports as directed by the Manager for resolution of A/R, claims, and projects
• Regularly meets with Manager to discuss and resolve reimbursement issues and billing obstacles
• Performs other duties as assigned

POSITION REQUIREMENTS AND QUALIFICATIONS:

Education and Experience Minimum:

High School diploma or equivalent required plus one year of hospital billing experience, including third party follow-up and customer service related duties.

Education and Experience Preferred:

Associates degree with a minimum of two years experience in hospital billing or a related field or the equivalent combination of education and experience.

Skills Minimum:

• Establishes and demonstrates competency in accounts receivable systems and associated applications
• Knowledge of third party operations
• Knowledge of CPT, ICD9 utilized in medical billing and medical billing terminology
• Fluency with automated patient accounting systems
• Excellent customer service skills to communicate effectively with insurance carriers, patients, and colleagues
• Excellent communication skills including oral comprehension/ expression and written correspondence
• Ability to work independently, exercising good judgment, and multi-task in a high stress, fast-paced service environment with patients, patients family, insurance carriers, and leadership
• Ability to maintain professional conduct and good working relationships with staff, management, and payers
• Detail-oriented with good analytical problem-solving skills
• Ability to comply with procedural guidelines and instructions and to solicit assistance when situations arise that deviate from the usual and customary

Skills Preferred:

These are in addition to those listed under Minimum

• Industry certification (AHIMA, HFMA, AAPC, etc.)
• EMR experience (Epic preferred)
• Microsoft Office proficiency