• Coordinates billing and reimbursement activities in accordance with regulatory compliance and organizational billing guidelines
  • Ensures all claims are submitted daily with a goal of zero errors
  • Completes daily billing, reviews claims for errors, and resolves billing edits in timely manner
  • Processes payments as appropriate in accordance with contracts and policies to ensure that all potential liabilities are paid in a timely and accurate fashion
  • Analyzes and reviews claims to ensure that payer-specific billing requirements are met
  • Reviews, researches, and resolves payment delays and/or variances resulting from rejected and/or denied claims, overpayments, and underpayments
  • Submits paper claims for secondary and supplemental insurance companies with copy of primary Explanation of Benefit (EOB)
  • Resolves routine patient billing inquiries and problems
• Facilitates all institutional/professional Out of Network (OON) billing, claims, denials, and appeals processes
  • Applies knowledge of specific OON payer payment rules, managed care contracts, reimbursement schedules, eligible provider information and other available data and resources in order to research payment delays and variances, make corrections, and take appropriate corrective action to ensure timely claim resolution
  • Bills and follows-up on OON claims timely
  • Responds to inquiries by OON insurance companies in timely manner to appeal denials and/or negotiate underpayments with OON payors
  • Prepares appeals summaries while ensuring compliance with organization standards and regulatory requirements
  • Resolves claim(s), conducts formal account reviews; identifies lost charge recovery; analyzes and documents delays and payment variances
• Reviews and analyzes coverage guidelines and compliance for billing of all payor classes and assists with audits and denials
  • Identifies systemic issues; resolves or escalates to manager and/or director
  • Interprets data, draws conclusions, reviews findings and provides recommendations
  • Proactively follows up on payment delays and variances by contacting patients and third-party payers and supplying additional data as required
  • Conduct write offs, transfers, allowances, and reversals
• Collaborates and trains across various functions to advance departmental efficiencies
  • Assists in delivering department services efficiently; Trains, advises, assigns, or reviews work in the department
  • Coordinates follow-up activities with utilization review, case management, coding, and nurse liaison personnel to provide required clinical support; ensures timely follow-up and action for account appeals
  • Collaborates with patient access and other necessary parties to resolve account authorization issues
  • Collaborates with internal and external stakeholders to ensure efficient and compliant reimbursement operations
  • Maintains knowledge of state and federal laws as they relate to contracts, OON, and the appeals process
  • Follows instructions from Patient Financial Services Manager and/or designee to perform other functions as assigned in order to achieve the goals within the department
  • Participates in special projects as directed

Memorial Health System has been dedicated to healing, inspiring, and transforming the health of our community since 1946. With multiple hospital facilities, outpatient surgery locations and diagnostic centers, more than 100 Physician Clinics, and post-acute services including skilled nursing, you can find your fit at Memorial.

When you join our team, you join more than 5,000 individuals committed to exceptional care. We offer several of the region’s most comprehensive clinical programs and medical specialties unique to the Coast, including a Level III Neonatal ICU, state-designated Level II Trauma Center, Hyperbaric Oxygen Therapy, and Mississippi’s first nationally-certified Primary Stroke Center.

At Memorial, you are valued. We know that our increasingly diverse communities need healthcare professionals that reflect their different cultural backgrounds, perspectives, and values. We acknowledge the uniqueness of all individuals, their commonalities as well as differences, all of which have shaped their lives in meaningful ways.

The development of our team members is integral to the patient care we provide. Grow your skills, and grow with Memorial.

Memorial Health System is an equal opportunity employer and does not discriminate on the basis of any legally protected status or characteristic. Minority/Female/Sexual Orientation/Gender Identity/Disability/Veteran.