Trinity Health Billing and Follow-Up Representative in Mason City, Iowa
The Billing & Follow-Up Representative reviews, researches, and processes claims in accordance with contracts and policies to determine the extent of liability and entitlement, as well as to adjudicate claims as appropriate. The core responsibilities will include: coding and processing claim forms; reviewing claims for complete information, correcting and completing forms as needed; accessing information and translating data into information acceptable to the claims processing system; and preparing claims for return to provider/subscriber if additional information in needed. Additional follow-up responsibilities include: maintaining all appropriate claims files and following up on suspended claims; assisting, identifying, researching and resolving coordination of benefits, subrogation, and general inquiry issues, then communicating the results; and preparing formal history reviews.
Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
Submits 3rd party and patient claims (electronically or by hard copy), including the maintenance of bill holds and the correction of errors in an effort to provide timely, accurate billing services. Edits UB-92 (and where appropriate HCFA-1500) claim forms within the patient accounting system, using proper data element instructions for each payer, applying principles of coordination of benefits, and ensuring that correct ICD-9 diagnosis, HCPCS and CPT procedure codes are utilized. Ensures that claims are in accordance with regulations set forth by the state and federal governments, 3rd party payers, and Trinity Health guidelines.
Performs all billing and follow-up functions, including the investigation of over-payments, underpayments, payment delays resulting from denied, rejected and/or pending claims, with the objective of appropriately maximizing reimbursement based upon services delivered and ensuring that the claim is paid/settled in the most timely manner. These functions will be in coordination with the Central Operations team, depending on threshold metrics defined by work queues for the Shared Service Centers and Central Operations.
Utilizes available data and resources to make decisions regarding complexity of claim processing and payment propensity, and the appropriateness of transferring account to the Disputed Claims Management team, Collection vendor(s) or other resources for follow-up;
- Researches claim rejections, making corrections, taking corrective actions and/or referring claims to appropriate staff members for follow through to ensure timely claim resolutions;
- Proactively follows-up on delayed payments by contacting patients and 3rd party payers, and supplying additional data, as required;
- May perform financial counseling activities, including but not limited to:
- Seeks appropriate funding based upon patient requirements, collecting supporting documentation (payroll stubs, tax returns, credit history, etc.), as required. Provides information and education to the patient, family member and/or guarantor of the application/documentation process. In so doing, the incumbent will encourage patient participation in the funding process and will assist the patient in forwarding the required documentation and application to the appropriate funding agency:
- Counsels patient/guarantor on patient’s financial liability, third party payer requirements and outside financial resources, including private organizations and foundations, eligibility vendor(s), Medicaid, Medicare, Champus, and/or federal disability programs, etc.;
- Counsels patient/guarantor of payment plan options and establishes appropriate plan;
- Investigates No Fault and Workers’ Compensation cases, retrieving police report and insurance information, as required;
- Assists patient/guarantor in completing a charity application, financial statement and/or payment contract when required according to hospital policies. Analyzes such applications along with income/resident documentation in order to advise the patient of available options. Initiates requests for charity write-off, when appropriate;
- Analyzes financial and eligibility data, and length of disability to determine potential eligibility for federal, state, and/or county programs, completing the necessary documents within the time limits specified by the appropriate government agency;
- Determines and manages proper course of action for optimal reimbursement of healthcare charges (e.g., spend down eligibility, out-of-network, Cobra coverage, etc.); and
- Informs patient/guarantor of flat-rate and discount programs and assists patient in application process, ensuring that adjustments are requested and completed.
- Evaluates accounts, resubmits claims, and performs refunds, adjustments, write-offs and/or balance reversals, if charges were improperly billed or if payments were incorrect; and
- Updates and refiles claim forms in a timely, accurate manner.
Responds to patient and 3rd party payer inquiries (telephone, fax, mail and web-based patient portal), complaints or issues regarding patient billing and collections, either responding directly or referring the problem to an appropriate resource for resolution.
Communicates with physicians and their office staff, Patient Access, Medical Records/Health Information Management, Utilization Review/Case Management, Managed Care, Ancillary and Nursing staff, as required to clarify billing discrepancies, and obtain demographic, clinical, financial and insurance information.
May prepare special reports as directed by the Manager to document billing and follow-up services (e.g., Number of claims and dollars billed, number of claims edited, number of claims unprocessed, etc.).
May serve as relief support, if the work schedule or workload demands assistance to departmental personnel. May also be chosen to serve as a resource to train new employees. Cross- training in various functions is expected to assist in the smooth delivery of departmental services.
Other duties as needed and assigned by the manager.
Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
High school diploma or an equivalent combination of education and experience. Associate degree in accounting or business administration high desired. Data entry skills (50-60 keystrokes per minutes). Past work experience of at least one year within financial services setting, performing medical claims processing, financial counseling, accounting, financial clearance and/or customer service activities is required. Previous work experience of at least one year of a health care setting is strongly preferred.
Knowledge of insurance and governmental programs, regulations and billing processes (e.g., Medicare, Medicaid, Social Security Disability, Champus, Supplemental Security Income Disability, etc.), managed care contracts and coordination of benefits is strongly preferred.
Working knowledge of medical terminology, anatomy and physiology, medical record coding (ICD-9, CPT, HCPCS), and basic computer skills are highly desirable.
Excellent communication (verbal and writing) and organizational abilities. Interpersonal skills are necessary in dealing with internal and external customers. Accuracy, attentiveness to detail and time management skills are required.
To successfully accomplish the essential job functions of this position, the incumbent will be required to work independently, read, write, and operate keyboard and telephone effectively.
Must be comfortable operating in a collaborative, shared leadership environment.
Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.
PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS
Must be able to set and organize own work priorities, and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles. Excellent problem solving skills are essential.
This position requires the ability to comprehend and retain information that can be applied to work procedures to achieve appropriate service delivery.
The greatest challenge in this position is to ensure that billing and follow-up activities are performed promptly and in an accurate manner to assist in order to reduce potential financial loss to the patient and the Ministry Organization. The incumbent must have a thorough knowledge of various insurance documentation requirements, the patient accounting system, and various data entry codes to ensure proper service documentation and billing of the patient's account.
Position operates in an office environment. Work area is well-lit, temperature controlled and free from hazards. The incumbent is subject to eyestrain due to the many hours spent looking at a CRT screen. The noise level is low to moderate.
Completion of regulatory/mandatory certifications and skills validation competencies preferred.
Must possess the ability to comply with Trinity Health policies and procedures.
Job Number: 00122375
Location: Mason City, IA
Organization Name: Trinity Health
Facility: SO - Iowa PFS Shared Service Ctr
Employment Type: Full time
Shift: Day Shift