GENERAL PURPOSE :

Under the general supervisor of the PFS Director, this position will be the primary contract for 3rd Party Collections and act as liaison between the insurance carriers and hospital to maximum revenue that are reflective of the hospital’s services. Will organize contract audits of hospital accounts receivable with minimal supervision. This position will have responsibilities for the aging of Medicaid and 3rd party accounts and relaying information regarding coverage and/or payment changes to the PFS Director.

ESSENTIAL FUNCTIONS:

This position is responsible for the day to day collection from 3rd party accounts and coordinating of Patient Financial Services to increase cash flow. Analyzes and reviews claims for accuracy, completeness and eligibility. He / She will also see all write-offs and contractual adjustments applied correctly to accounts. Responsible for handling all outside vendors, internal departments to increase cash flow and monitor all activities related to cash flow. Addresses accounts over 60 and 90 days or more with staff and outside agencies. Prepares and maintains reports and records for processing. Will review payment posting and review adjustments to verify correct posting to accounts.

DUTIES AND RESPONSIBILITIES :

• Researching high value claims assuring expected reimbursement. Identifying errors to determine their origin and appropriate resolution.
• Review, research, and resolve complex claims processing issues involving high dollar accounts.

• Secures needed medical documentation required or requested by third party insurances.
• Submit errors back to the proper source timely and manage the response.
• Works closely with Business Analyst to complete Quality and Audit projects.
• Uses critical thinking and past experience to identify issues and work on solutions.
• Keeps updated on all third-party billing requirements and changes for insurance types within the area of responsibility.
• Maintains third-party billing logs.
• Ability to work independently.
• Takes initiative to identify and suggest process improvements
• Answers telephones and provides information in accordance with Hospital and department policy. Takes and relays messages.
• Demonstrates knowledge of and supports hospital mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality standards, and the code of ethical behavior.
• Performs other duties as assigned.

SKILLS AND ABILITIES REQUIRED :

• Must have the ability to work well with the general public and have a good working relationship with the Patient Financial Services Director, Administrator, and other personnel directly involved in the operation of hospital financial functions.
• Must possess computer skills and knowledge of MS Office, Cerner, online insurance, online vendor applications, and other office equipment required for this position.
• Demonstrates the ability to effectively and efficiently communicate verbally and in writing.
• In-depth knowledge of medical terminology.
• Must be able to work independently with minimal supervision, showing initiative and being a self-starter.

EDUCATION AND EXPERIENCE REQUIRED :

• High School Graduate, college preferred.
• 8 years of hospital claims experience, including 4 years of claims auditing.
• Must have a technical, systematic, and goal driven attitude.
• Must have a minimum of 5 years collection experience in a hospital or medical office setting.

Job Type: Full-time

Pay: $20.00 - $24.00 per hour

Ability to Relocate:

• Boulder City, NV: Relocate before starting work (Required)

Work Location: In person