at ROCHELLE COMMUNITY HOSP ASSN7 in Rochelle, Illinois, United States
Job Description
GENERAL APPLICATION INFORMATION: Rochelle Community Hospital is an Equal Opportunity Employer. All qualified applicants will be considered without regard to race, color, religion, gender, national origin, sexual orientation, age, marital status, medical condition, disability, protected veteran status, or any other legally protected status. No sponsorships available
ALL RESUMES AND APPLICATIONS NEED TO BE SUBMITTED THROUGH ILLINOISJOBNETWORK.COM TO BE CONSIDERED. Please be advised that your application is not complete until you fill out, sign, and submit an Application for Employment for a specific position for which Rochelle Community Hospital is actively recruiting. Your application must reflect that you possess the required qualifications for the position.
Position Summary:
Position reports directly to the Patient Financial Services Coordinator and is responsible for timely and accurate Medicare and Medicaid billing (including Managed Care Medicare-C / Medicaid MCO), follow-up, and payment reconciliation. Understands and follows guidelines for appropriate billing on UB04 and HCFA 1500 claim forms. Identify appropriate primary and secondary payers and ensure claims are billed appropriately. Understands and follows billing regulations as established by federal and state payers. Follow up on denied and/or un-paid claims to ensure account resolution. Coordinates billing and follow-up procedures with outsource agency performing Medicaid billing.
Duties and Responsibilities:
Understand and follow Rochelle Community Hospital’s Standards of Excellence. Greet all guests utilizing excellent customer service. Display respect and dignity to patients, visitors and staff. Uphold hospital policies and maintains a code of confidentiality on all patient information.
Welcomes patients and visitors to the hospital and interacts in a customer focused and compassionate manner to ensure patients and their representatives’ needs are met, that they understand their financial responsibility for services received, including charity care assistance program.
Perform appropriately in difficult situations by remaining calm, notifying appropriate personnel and initiating appropriate action for patient accounts receivable resolutions.
Assist payment processor in processing Medicare and Medicaid remittance advices to properly post payment and contractual allowances.
Interpret Medicare and Medicaid requirements necessary to obtain proper payments in compliance with government billing regulations. Investigate potential charge/coding problems and forward recommendations to Manager for system updates according to CPT/HCPC and CCI edits. Investigate denials/edits for claim resolution. Insure patients are only billed for those balances of charges deemed their responsibility by posting contractual allowances. Coordinate efforts with HIM coding staff for denial investigations.
Analyze receivable aging reports and work queues for claim resolution. Identifies potential problems and takes appropriate action on un-paid claims. Follows-up on unpaid claims to ensure all collection efforts are met prior to determining account balance is a self-pay portion.
Follow Medicare bad debt regulations to identify accounts uncollectible. Record bad debt activity for audit purposes. Must remain knowledgeable of Medicare regulations by identifying and reporting only allowable amounts on the cost report as a bad debt. Rochelle Community Hospital is not a Method II provider, therefore professional fees are not to be reported in bad debt logs.
Accurately prepares Medicare Quarterly Credit Balance report and coordinates with Manager and/or CFO to submit on a timely basis as defined by the Medicare MAC. Reviews credit balances on a regular basis. Analyzes if credit is due to incorrect posting of payment/contractual allowance or credit is to be refunded to third party payer or patient. Coordinates with patient account analyst to prepare appropriate paper work for credit balance refund as needed.
Maintain third party logs in information system for designated payers according to established guidelines. Review logs for completeness, insures logs are accurate and ready for annual audit and cost report preparation.
Coordinate with outside extended billing office for any information needed to accurately bill Medicaid claims. Acts as the liaison between PFS staff, Case management and HIM staff as needed for Medicaid billing.
Accurately records patient telephone calls, patient and payer inquiries, collection activity and other account follow-up in hospital information system. Insure support... For full info follow application link.
Equal Opportunity Employer. All qualified applicants will be considered without regard to race, color, religion, gender identity, national origin, sexual orientation, age, marital status, medical condition, physical or mental disability, protected veteran status, or any other legally protected status.
