Essential Duties and Responsibilities include the following:
- Manage underpayment /overpayments account follow-up and internal escalation
- Reconcile account balances and adjustment to assure accurate status
- Resolve underpayments through daily communication with payors
- Identify trends in underpayment/overpayments, denials, revenue opportunities and revenue leakage
- Evaluate trends and works towards resolution and improvement of revenue cycle processes
- Interpret contract reimbursement and provide feedback to the department
- Work with financial and clinical departments collaboratively
- Review contract validation, updates and interpretation
- Resolve underpaid/overpaid claims in an effective and timely fashion
- Ensure account analysis is validated prior to distribution
Qualifications:To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Highly organized
- Initiative to work independently
- Proficient with telephone and email communications
- Excellent interpersonal skills required to communicate with direct staff and internal/external customers
- Ability to prioritize and work on multiple projects/initiatives at a time
- Must possess excellent time management and organizational skills and possess the ability to work independently
Education/Experience/Skills:
- High School graduate or equivalent
- Minimum of 1 (one) year of hospital revenue cycle experience, relevant education may substitute experience requirement
- Maintain applicable continuing education requirements
- Knowledge of CPT, HCPCS, DRG, reimbursement methodologies, and revenue codes
- Billing/Collections experience on UB 04 claims
- Experience with ICD 10
Reasoning Ability: The collector must have the ability to define problems collects data, establish facts, and draw valid conclusions. The collector must have the ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.Computer Skills:To perform this job successfully, an individual should have:
- Required PC competencies including intermediate Microsoft Office skills
Physical Demands:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.INDSS