Senior Patient Accounts Processor (Req 101115)

About the role

Be a part of the mission at Whitney Young Health (WYH) to provide high quality healthcare that is affordable and accessible to our diverse community.

Responsibilities

• Ensures the financial integrity and Accounts Receivable by performing established financial processes that enable and expedite the billing and collection of medical services, including:
  • Creating claims according to regulations and compliance guidelines
  • Patient account research and resolution
  • Insurance verification and benefit determinations
  • Identification of reimbursement issues
  • Resolution of credits and issuance of refunds
  • Identification of payment variance invoices
  • Follow up and resolution of denied claims
• Responsible for working correspondence denials and insurance follow up in a timely and accurate manner
• Assists with the training and orientation of employees on billing functions
• Responsible for encounter/claims creation and billing in correct format as required by payer
• Inputs, reviews and updates all demographic and insurance data as necessary
• Process pending claims as directed by Director and/or Manager of Revenue Cycle
• Timely submission of claims to the clearing house and reconciling clearing house reports
• Monitor and execute work against the assigned Tier(s) and team associated Custom Claim Worklist(s), relational AR Worklist(s), reporting, projects, or team / department goals
• Oversight of HOLD/Tier 1 Worklists and monitor Missing Slips to ensure timely charge capture
• Review and adjudication of clearinghouse rejections
• Processes third party payments, denials, and carrier inquiries via receipt of ERA, paper, and any pertinent method
• Contacting payers via phone or website, contacting practices, navigating cross-departmentally, writing appeals and facilitating their direction to Athena CBO for submission, and all other activities that lead to the successful adjudication of eligible claims
• Informs Director of reasons for claims denials and other changes in claims adjudication including recommending claims for write off
• Work and resolve unpostables, manage remittance and all correspondence in each of the dashboards daily
• Work and resolve Zero-Pay Worklist, Fully Worked Receivables, complete special project work, review and respond to adjustments / payment data with approval (or initiate appeal) communicate trends and root issues through proper lines of reporting
• Receive calls or emails from Patient Financial Specialists with patient’s requesting advanced assistance with their account
• Reconciles employees’ medical and dental accounts including posting employee payments, applying employee dental discounts based and adjusting non-billable services/vaccines that are required by WYH for employment purposes and co-pays when appropriate
• Develops solutions to claim processing and payer adjudication problems
• Learn and keep up to date on payer billing requirements, changes in medical/dental practices, and coding
• Assists with the implementation of any and all process improvement initiatives including developing policies and procedures
• Reviews and transfers patient charges over 120 days to collection vendor as instructed by Director and/or Manager Revenue Cycle
• Completes patient itemized statements upon request
• Manages/Assists on supplemental claims billing as instructed by Director and/or Manager Revenue Cycle
• Assists in working with other departments to resolve inquiries from staff and/or patients (i.e. accounting, IA’s)
• Works in a collegial and cooperative manner with staff in the department and throughout WYH
• Completes all other patient accounts functions and steps not specifically identified above but resulting from continuous performance improvement activities and periodic training sessions
• Participates in monthly staff meetings and attends monthly payer meetings as requested by the Director of Revenue Cycle
• Provides support to other staff to include additional training, back up, and other assistance as needed
• Learns and keeps up to date on all programs and services offered at WYH
• Available to work overtime as needed
• Demonstrates excellence in both internal and external customer service
• Tracks weekly production and sends report to Director Revenue Cycle for weekly quality and productivity review
• Keep management informed of correspondence and communication problems with service locations
• Maintains productivity and quality standards
• Maintain knowledge and understanding of insurance billing procedures to understand the reason for claims in HOLD, MGRHOLD and OVERPAID status to ensure resolution and timely payment
• Demonstrates excellence in both internal and external customer service
• Understands and is able to effectively communicate HIPAA compliance, corporate compliance and client confidentiality
• Ensures and/or remains in compliance with local, state, and federal regulations
• Adheres to the National Patient Safety Goals as defined by the Joint Commission and the Whitney M. Young Jr. Health Center
• Completes other duties as assigned

Requirements

• High school diploma or GED
• Excellent oral and written skills
• Competent in use Microsoft Office applications, especially Excel
• Exceptional ability to make good decisions in accordance with WMY policies and procedures
• Strong ability to positively function with internal and external customers in a medical billing office setting
• Two years experience as a Medical Biller/Claims Examiner/Claims Analyst demonstrating the ability to bill using accurate coding and independently resolve claim problems through to payment
• Working knowledge of medical terminology, CPT4 and ICD coding, and experience with claims billing software

Preferred Qualifications

• Bilingual candidate
• Experience with Athena, Denticon or 10E11, billing software preferred
• Two years coding experience preferred

Benefits

• Generous time off
• Affordable health, dental and vision insurance
• 401k with safe harbor employer match
• Tuition reimbursement
• Term life insurance
• Commuter benefits

Pay

$23.54 hourly