Accounts Receivable Clerk - Home Health & Hospice

Billing and Collections

• Maintain, obtain, retain and apply knowledge regarding the specific billing requirements for Medicare, Medicaid, all other third party commercial insurance funding sources; other federal, state, county, local programs; and, direct billing and collections of amounts due directly from the patients/consumers.
• Prepare and transmit all claims electronically using specified software, as well as insurance carrier and other governmental agency internet portals within established monthly billing performance timeframe and by prescribed due dates.
• This includes billing primary and secondary third party agencies.
• Review and balance all assigned ancillary service files provided by various vendors by the prescribed dates for the month end close billing cycle to ensure all ancillary services are captured in billing files to enable accurate claims.
• Adequately scan required documents into the electronic medical record for the date required prior to claims release.
• Adhere to supervisory internal control review requirements before release of claims.
• Validate payer data for patients that intake personnel identified to ensure the proper third party payer, as indicated by the payer guide, and make corrections when necessary.
• Ensure that all required documents are scanned into the electronic medical record for the date required prior to claims release.
• Identify and escalate site or payer related issues to supervisor/manager in a timely manner.
• Monitor status of collections and appropriate cash receipt application to correct patient account balances.
• Identify denied claims on a daily basis. Research, correct and resubmit claims on a daily basis via prescribed software, third party and government agency internet portals, or mail if only option.
• Escalate any continuing or complicated matters to supervisor/manager for additional attention and potential consultant advisory.
• Communicate with third party and governmental agencies to facilitate successful correction and payment of claims when necessary.
• Communicate with site representatives when necessary to assist in resolution of denied claims.
• Assemble information to enable responses to additional development requests to support clinical necessity of claims, and for cases where grievance or appeal is appropriate.
• Communicate with site and corporate representatives as necessary to facilitate responses to third party agencies.
• Track and report status.
• Prepare, review and release private pay invoice statements, using specified software, within established monthly billing performance timeframe and by prescribed due dates.
• Invoice statements should be completely accurate with minimal and infrequent errors subsequently discovered.
• Adhere to supervisory internal control review requirements before release of claims.
• Established supporting documents or special statement inserts must be included in the mailing.
• Field incoming patient, consumer, and/or appropriate family member or guardian calls or emails in a professional and responsive manner.
• Perform appropriate account research and activity verification.
• Develop thoughtful and accurate response and send to inquirer.
• Escalate more complex matters to supervisor/manager when appropriate.
• Make collection calls at prescribed intervals.
• Prepare and send collection letters at prescribed intervals.
• Develop payment plan options when appropriate and within prescribed guidelines.
• Refer certain accounts to attorneys or collection agency upon supervisor/manager approval.
• Review accounts receivable aging reports to identify outstanding balances and take appropriated action to research and resolve outstanding balances.
• Goals for overall days in accounts receivable, targeted outstanding balances needing resolution and expecting timing will be established on a monthly basis by supervisor/manager.

Financial Management and Support

• Prepare and provide for review and approval all accounts receivable write-off and other types of revenue or receivable balance adjustments as needed with all required supporting documentation.
• Identify and notify supervisor/manager of other potential issues through use of various reports that may indicate the need to make revenue, receivable, payer, or rate corrections to ensure that revenue and receivables are recorded accurately and timely.
• Identify and offer suggestions pertaining to process improvements.
• Communicate collaboratively with other account receivable coordinators to resolve any common patient/consumer receivable matters.
• Successfully transition through payer education requirements by pre-determined deadlines, including all payer facility contracting relationships, payer rules and regulations and payer appeals and grievances process.
• Participate in recurring team meetings and trainings.
• Aid and/or be present for site personnel trainings.
• Prepares other special reports and performs other tasks or projects as requested and/or required.