Responsible for registration, insurance authorizations, billing third party payers and account follow up on outstanding denied or underpaid account receivables and all direct and indirect communication with Villa Pomerado patients as it relates to their visit financially. Ensure all financial clearance strategies meet the patient centric model. Ensure authorizations are received and managed appropriately to secure insurance reimbursement. Strive to accommodate the patient needs and advocate on behalf of the patient to ensure the financial burden is one that the patient is able to manage and feels that on each visit that the PFAS treated the patient with the utmost consideration, compassion and personalized service. The model will ensure a patient friendly environment for financial strategies and thereby reducing bad debt. Responsible for the appropriate billing of Skilled Nursing accounts to government payers as well as commercial payers. Ensure the appropriate payment is received, appealing any underpayments and/or denials as appropriate. Bill patients for their coinsurance, deductibles, share of cost, and non-covered services such as beauty shop charges, etc. Must have the ability to perform complex mathematical calculations to adjudicate accounts appropriately. Must have ability to analyze and adjudicate complicated contractual arrangements. Reviews remittance codes from explanation of benefits (EOB) and remittance advices (RA). Work directly with the patient and patientï¿½s family from the start of the patientï¿½s visit through at registration, to completion of their account to ensure a transparent fluid process handling allowing for a fully patient centric and personalized service. Follow their patient through the entire Revenue Cycle and be an advocate for their patient account until full financial resolution has been achieved. Demonstrate the ability to build teamwork through open communication and collaboration among team members. Actively participates on SNF multi-disciplinary team. Speak and read English at a level that is sufficient to satisfactorily perform the essential functions of the position. Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, Powerpoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job. Performs other duties as assigned. Follows Palomar Health rules, policies, procedures, applicable laws and standards. Carries out the mission, vision, and quality commitment of Palomar Health.
|Minimum Education: ||Associate Degree and/or combination of education and experience|
|Preferred Education: ||Basic college/medical coursework|
|Minimum Experience: ||3 years healthcare PFS experience or 2 years specialized Skilled Nursing|
|Preferred Experience: ||3 - 5 years Skilled Nursing Billing|
|Required Certification: ||Not Applicable|
|Preferred Certification: ||Not Applicable|
|Required License: ||Not Applicable|
|Preferred License: ||Not Applicable|
We are an equal opportunity employer and do not discriminate against applicants or employees based on race, color, gender, religion, creed, national origin, ancestry, age, disability, sexual orientation, marital status or any other characteristic protected by law.