|
General Summary of Position
Works independently to monitor and resolve denials and write offs received for outpatient accounts. Works in Excel creating and maintaining follow up on all accounts. Reports from Excel or other format will be required to show progress on receiving reimbursement from insurance companies. Looks for trends of non-payment from payers', provides feedback to outpatient departments with write offs and monitors improvements. Follows accounts to see if we are receiving full payment and trends and tracks revenue opportunities. Provides support for Financial Counselors. Works self pay elective OR accounts, stops cosmetic or sterilization procedures unless paid in cash. Primary Duties and Responsibilities
Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards and safety standards. Complies with governmental and accreditation regulations.Follows accounts finding opportunities to resubmit for full payment. When full payment hasn't occurred tracks and trends reasons. Monitors for timely follow up. Provides feedback to Access Director of findings.Follows up on accounts insurance cleared by Admitting or PFS. Looks in Siemens to see if there is an authorization and if not responsible party for not having insurance cleared. Uses insurance tools such as HDX, I exchange, Carefirst website and other insurance websites as required. Creates an excel report tracking and trending where responsibility of denial lies.Monitors and works denials report received from PFS. Distributes accounts to outpatient departments responsible for obtaining insurance clearance with expectation that department responds with authorization or reason for no authorization. Tracks and trends all responses from these departments. Monitors for timely follow up.Participates in multidisciplinary quality and service improvement teams as appropriate. Participates in meetings, serves on committees and represents the department and hospital/facility in community outreach efforts as appropriate.Performs other duties as assigned.Provides support for Financial Counselor as per current job description.Submits to PFS, authorizations, referrals or other findings that will allow reimbursement to hospital. Creates a report in excel and tracks results of submissions, whether rebilled, past statute of limitations, paid, not paid and reasons. Monitors for timely follow up.Works self pay elective OR accounts, stops cosmetic and sterilization procedures unless paid in cash.Active member of Denials Meeting for MFSMC and PFS Denials Committee.Works with Access and Ancillary Departments to help develop Best Practice".Remains up to date on insurance procedures and benefit changes and attends insurance seminars when available. Provides feedback related to insurance updates and changes to Access Director.Receives PFS Tracking Report and responds with necessary information for timely appeal.Works with the Managed Care Department and insurance companies to resolve insurance payment issues.Maintains close working relationship with PFS.Submits appeal requests.Assists in writing appeal letters for the appeal teams.Meets team specific benchmark as it applies to PXPAID, Disputed Claims, >$10K, >$20K, and credits.
Minimum Qualifications
Education
- High School Diploma or GED equivalent required
Experience
- 3-4 years experience in medical setting with strong insurance knowledge required
- Medical coding and denials management preferred
Licenses and Certifications
Knowledge, Skills, and Abilities
- Abilities Verbal and written communication skills.
- Basic computer skills with Microsoft Excel required.
- Working Knowledge in multiple specific payers' application billing and/or collection process.
- Requires basic working knowledge of UB04 and Explanation of Benefits (EOB).
- Requires some knowledge of Medical Terminology and CPT/ICD-10 coding.
This position has a hiring range of $20.17 - $35.04
|
MedStar Health
Feb 06, 2025