Job Description
Location: 8435 Stemmons Bldg.
Primary Purpose Reviews claims to resolve outstanding balances and secure accurate and timely payments from third party payors.
Education
•Must have a High School diploma or GED.
Experience •Must have three (3) years of experience in a hospital business office, physician business office, or insurance company, to include two (2) years of experience in medical billing and/or collecting from third-party payors
Equivalent Education and/or Experience •May have an equivalent combination of education and/or experience in lieu of specific experience as stated above.
Skills or Special Abilities •Must be able to demonstrate a working knowledge of personal computers and other standard office equipment.
•Must be able to exercise good judgment in handling government and/or non-government accounts and understand managed care and insurance contractual arrangements.
•Must have working knowledge of medical software.
•Must be detail oriented, possess basic mathematical skills, and have sharp analytical skills to resolve financial issues as they relate to multiple groups including third party payors, physicians, patients and the system.
•Must demonstrate a positive demeanor, good verbal and written communication skills, and be professional in both appearance and approach.
•Must be able to handle potentially stressful situations and multiple tasks simultaneously including discussing outstanding claims with the insurance company, taking action on denied claims, and processing appeals.
•Must be able to communicate effectively with patients, families, government entities, insurance companies, and Parkland staff.
•Must be able to solve problems within the guidelines of established policies and procedures.
•Basic medical terminology knowledge preferred.
•Bilingual skills preferred.
Responsibilities - Contacts payors to follow-up on outstanding claims for assigned accounts to verify reason for non-payment and corrects account, re-bills claim, and/or performs adjustments.
- Responds to routine denials from payors such as inability to identify the patient, coordination of benefits, non-covered services, past filing deadlines to ensure information is transmitted that is required to process payments. Performs required actions in order to resolve the account balance promptly by submitting appeals, correcting account information, coordinating requests for medical records, and posting account adjustments.
- Documents all actions taken on accounts in the system account notes to ensure all prior actions are noted and understandable by others.
- Performs routine audits of individual accounts to resolve all discrepancies in account balances.
- Informs the Supervisor of any problems or changes in payor requirements and exercises independent judgment to analyze and report repetitive denials so that corrective actions can be taken.
- Tracks productivity and provides cumulative reports on a daily, weekly or monthly basis, as required by supervisor and/or manager.
- Maintains a positive working relationship with contacts at all agencies, patients, insurance companies, government entities, clinical personnel, other Parkland staff and management, to promote teamwork, cooperation, and a positive public image for Parkland. Serves as a positive role model for staff and patients and demonstrates strong interpersonal skills. Accepts constructive criticism and integrates suggestions in effective ways.
Job Accountabilities - Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.
- Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
- Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.
Requisition ID: 989392
Job Tags
Work at office