Healthcare Reimbursement Advocate | Clinic

Job Summary

Responsible for the review, analysis, and complete resolution of outstanding self-pay account balances. Contacts patient account holders utilizing multiple methods including telephone, patient portal, direct patient contact, email or mail to negotiate and obtain payment of unresolved account balances. Interviews and counsels responsible parties regarding available payment opportunities according to the collection policies and procedures established by Monument Health, seeks payment in full or establishes payment arrangements within the guidelines of Monument Health collection policy. Conducts all communication in a manner that will result in a positive patient and family experience and ensure prompt reimbursement for all services provided.

Essential Functions

• Conducts all necessary review, analysis, and follow up on unresolved account balances from the complete Monument Health system utilizing a vast multitude of varying software packages and their functions, in accordance with established guidelines to ensure a positive patient and family experience.
• Demonstrates application of follow up processes necessary to ensure prompt, appropriate reimbursement and resolution of unresolved account balances due from responsible parties/patients.
• Demonstrates ability to communicate effectively and efficiently utilizing verbal and written skills. Contacts and counsels patient and family support teams by telephone, in direct contact interviews, and by utilizing written correspondence to provide satisfactory resolution of unresolved account balances in accordance within established timeliness standards and public relations guidelines to ensure a positive patient experience.
• Demonstrates application of reimbursement and collection policies according to established guidelines. Displays proficient application of all federal, state, and local regulations relating to the extension of Healthcare services, revenue cycle billing and collections, and all allowable follow up procedures and processes.
• Demonstrates this knowledge for third party payer groups including, but not limited to: Medicare, Medicaid, Champus, Blue Cross and all other third party contractual agreements entered into by Monument Health.
• Timely identifies additional or incorrect information causing errors on pending claims through direct communication with insurance companies. Researches and verifies the accuracy of transactions appearing on identified accounts, gathers and refers the necessary information to all subject matter experts to correct errors, expediting reimbursement and ensuring satisfactory account resolution and customer satisfaction.
• Maintains work areas in a neat and clean condition in accordance with any established guidelines and department expectations.

Required Additional Requirements

• Education - High School Diploma/GED Equivalent in General Studies
• Preferred Experience - 1+ years of Billing/Collections Experience; 1+ years of Healthcare Experience
• Education - Bachelors degree in Related Field

Physical Requirements

• Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.

Job Description

Conducts interviews and dialogue with patients, their families, and Monument Health subject matter experts in a professional manner utilizing public relation skills. Provides patient counseling to promote open communication, establish absolute comprehension and concern resolution, and initiate payment arrangements and/or financial assistance on outstanding account balances in accordance with established guidelines.

Reviews and identifies accounts which are absent of acceptable payment terms and performs the necessary actions to cycle those accounts to an appropriate agency for escalated collection activities. Runs reports and performs necessary skip tracing activities to locate responsible parties in a cost efficient manner.

Demonstrates proficiency in reimbursement and collection policies. Displays a working knowledge of third party payer procedures such as eligibility and verification, claims submission, reimbursement, as well as an understanding of collection policies. Demonstrates this knowledge for third party payer groups including, but not limited to: Medicare, Medicaid, Champus, Blue Cross and all other third party contractual agreements entered into by Monument Health.

Timely identifies additional or incorrect information causing errors on pending claims through direct communication with insurance companies. Researches and verifies the accuracy of transactions appearing on identified accounts, gathers and refers the necessary information to all subject matter experts to correct errors, expediting reimbursement and ensuring satisfactory account resolution and customer satisfaction.

Collaborates and effectively communicates pertinent information in a professional manner to promote a positive work environment with all internal Monument Health caregivers including but not limited to: Patient Financial Services Claims Analysts, Health Information Management, Patient Financial Services Third Party Financial Advocates, and all other divisions and department subject matter experts and caregivers.

Maintains work areas in a neat and clean condition in accordance with any established guidelines and department expectations.

All other duties as assigned.