Description

Responsible for implementation of compliant Revenue Cycle procedures including verification of insurance eligibility and benefits, obtaining authorizations for care, billing and collection of patient revenues, and transmission of OASIS and HIS assessments.

Core Competencies

Verifies patient’s insurance benefits from the payor, for services to be provided prior to the delivery of care. Transmits OASIS and HIS assessments in a timely manner through the QIES system while keeping errors below State mandated thresholds. Submits Notices of Election for Medicare Hospice Patients within the mandated time frame. Confirms all pre-bill edits have been cleared and all required signatures have been obtained prior to billing. Reviews bills prior to submission for payment for completeness and accuracy. Reviews Explanation of Benefits (EOB’s) and Remittance Advices (RA’s) and completes appropriate follow up which may include appealing full or partial denials, billing any unpaid balance to a secondary insurer, if one exists, or submitting the claim for the unpaid balance to the patient. Tracks and reports the status of claims denied and in the appeal process, including both payments and adjustments. Notifies Finance Manager and agency Administrator of any Medicare ADR’s. Assists in gathering documentation necessary to respond to the initial data requests and any subsequent appeals. Complies and submits for approval the supporting documentation for accounts to be granted a charity allowance or referred to an outside collection agency for further collection action. Reviews and reports on accounts outstanding beyond 60 from discharge or the end of episode. Reviews status of work queues and prioritizes job functions to ensure timely follow-up on patient accounts. Submits over the counter payments to the Business Office staff for deposit to the medical center’s account. Receives and answers inquiries from patients and insurance companies regarding charges and/or billing discrepancies. Reconciles daily deposits with the amounts posted to the agency’s accounts receivable system. Reconfirms insurance benefits periodically throughout the patient’s care and annually reconfirms benefits of all patients on service. Performs reconciliation of cash deposits to the Accounts Receivable trial balance on a monthly basis prior to submitting the Journal Entry for Month End Close. Prepares requests for refund for those accounts that have been paid more than allowable. Completes the Medicare quarterly Credit Balance Report and submits the trial balance and the supporting documentation for review and approval. Stays informed of updated insurance requirements and reimbursement practices. Assists with training of new staff members. Reviews utilization to ensure authorizations are obtained timely for those services that require prior authorization. Ensures all billings are audited prior to billing. Prepares ad hoc reports for the Director, Revenue Cycle, as needed. Participates in hospital performance improvement activities (kaizens, lean initiatives) when appropriate. Follows departmental downtime procedures during period of computer network interruption to support department staff.