JOB DESCRIPTION OVERVIEW:
This position is responsible for reviewing invoices on all carriers at their assigned facility. Maintains accuracy and production to ensure accounts receivable is being processed effectively.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Reviews Medicare invoices at 45 days aging to identify potential problem areas for each assigned facility;
- Reviews Medicaid/TennCare invoices at 45 days aging to identify potential problem areas for each assigned facility;
- Reviews Workers' Compensation for invoices at 75 days aging to identify potential problem areas for each assigned facility;
- Reviews commercial, managed care, and BC/BS invoices at 75 days aging. Claims with no activity within 75 days will be rejected to Patient Responsibility;
- Contacts Medicare, Medicaid, and TennCare to inquire on unpaid claims;
- Assembles and forwards appropriate documentation to the A/R Manager for provider related issues;
- Assembles and forwards appropriate documentation to the appeals unit for disputed Medicare, Medicaid and TennCare claims;
- Monitors and updates fee schedules as needed;
- Reports any consistent errors identified during review that affect claims from being processed correctly;
- Prepares work file assignment report on all work files;
- Participates in unit progress meetings with Accounts Receivable Team regarding Accounts Receivable;
- Turns to A/R Manager for unusual circumstances that may include adjustments, denials, fee schedules, claims, etc.;
- Performs any and all duties as directed by Accounts Receivable Hospitalist Manager.
QUALIFICATIONS / EXPERIENCE:
- High school diploma or equivalent required;
- Previous medical billing experience with primary emphasis on Government programs, such as Medicare, Medicaid, TennCare;
- Good computer skills;
- Excellent communication skills both oral and written;
- Ability to meet deadlines and work overtime as needed;
- Regular and predictable onsite attendance;
- High level of interaction and team work.
PHYSICAL / ENVIRONMENTAL DEMANDS:
This job should be performed in a well-lighted and well-vented environment. Requires constant sitting tolerance. Extended amount of time spent in front of computer display terminal. This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key, calculator, office machines (copier, scanner, fax) and/or the ability to perform repetitive motions and/or meet production standards to comply with the essential functions. Also, may require physical and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more than five days per week.
Cooperative, positive, courteous and professional behavior and conduct is an essential function of every position. All employees must be able to work with others beyond giving and receiving instructions. This includes getting along with co-workers, peers and management without exhibiting behavior extremes. Job functions may require personal leadership skills such as conflict resolution, negotiating, instructing, persuading, speaking with others as well as responding appropriately to job performance feedback from the supervisor. Additionally, the information contained in this job description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position.
Maintain Indexed Record
Generally Accepted Accounting Principles