Job Summary:

• Responsible for accurately and timely posting of self- pay, insurance payments, related contractual adjustments and denials through 835 electronic remits and/or manual posting method
• Address all payments on hold: both in the 835 electronic posting program and hard copy mail checks.
• Investigates the source of unidentified payments to ensure they are applied to appropriate accounts. If necessary will contact the sender to clarify where the payment should be posted.
• Reconciles shortages on both electronic EOBs and paper remits to determine proper allowance and correct write off.
• Analyses EOB information, including co-pays, deductible, co-insurance, contractual adjustments, denials and more to insure accuracy of patient balances.
• If it is determined insurance did not pay per contract, refer to the correct follow up person for additional action
• Enters both electronic, paper and denials and additional information requests from Insurance so it can be pushed over to appropriate teams for follow up
• Coordinates shared payments received with other billing systems. Makes sure all batches are labeled so they can tie out to each other.
• Add appropriate ANSI denial codes and comments to assure all necessary appeals and post payment review can take place
• Distributes payment remits, hard copy denials and miscellaneous correspondence to billing teams and Denial Management Coordinator
• By end of each day- scans all EOB’s into PDF searchable format, using the correct naming convention. Moves all files to appropriate drive.
• By end of each day- makes paper file for all paper EOB’s
• By end of each day- scans all batch reconciliation information to appropriate drive to create an appropriate audit trail.
• Reconciles EFT lists received from the Finance Department to guarantee all electronic funds received are posted
• On a daily bases compile list of deposits sent to bank: send copy to bank with daily deposit, keeps copy for next day to reconcile returned deposit receipt. Works will Bank when discrepancies are found to insure all deposits are appropriately accounted for.
• Each day updates all pertinent spreadsheets for auditing and tracking of cash batches/transactions
• Handles telephone questions and concerns from customers; ensures complaints and inquiries are recorded and reported to management
• Records appropriate, up to date notes in patient accounts, and provides insurance collectors account for follow up.
• Updates patient account information as necessary.
• Maintain high level of productivity through speed and accuracy
• Work with as a team to achieve daily, weekly , monthly deadlines
• Performs other duties as assigned
• Basic knowledge in downloading/creating spreadsheets in Microsoft Excel

KNOWLEDGE/EXPERIENCE:

• Previous work experience in insurance billing regulations and understanding insurance contracts preferred but not mandatory.
• Knowledge of state and federal regulations as they relate to the billing process preferred but not mandatory.
• Strong data entry, ten key skills and working knowledge of computer required.
• Exceptional customer service and interpersonal communication skills.
• Proficient in examining documents for accuracy and completeness.
• Ability to multitask and manage time effectively.
• Ability to handle payments in accordance with detailed instructions.

EDUCATION: High School diploma or GED preferred. Completes Patient Financial Services I training within first 5 months.

LICENSE/CERTIFICATION/REGISTRY: None Required

APTITUDES:

• Ability to read and understand different explanation of benefits (EOB)
• Analytical abilities to successfully balance payer remittance against software posting transactions
• Ability to achieve cognitive, organization and emotional maturity to deal effectively with multiple tasks, stresses, deadlines, difficult situations and/or customers.
• Possesses interpersonal/communication skills necessary for effective, non-judgmental, and empathetic patient care and customer relations.
• Open to feedback and a changing environment, which requires flexibility in scheduling and department assignments.
• Create, maintain, and promote a respectful work environment consistent with SPH patient and employee standards.
• Ability to make decisions and troubleshoot using various resources available.
• Attention to detail and accuracy
• Ability to accurately, and efficiently document customer interactions
• Must possess a customer-focused mindset.

9010.578