Requisition ID: 49699

Location: Presence St Mary Chicago

Location Address:
2233 West Division Street, Chicago, IL 60622 United States (US)

Daily Hours: 4
Standard Hours: 20
Employment Status: Part-time
Employment Type: Regular
Shift: Day
FLSA: N

Provide billing and follow-up related to patient/customer complaints and advocacy for patients related to complaints or billing issues. Ensure proper submission and adjudication on all claims submitted to third party carriers/intermediaries. Respond to all inquiries according to CBO policy and procedures.

ESSENTIAL DUTIES AND RESPONSIBILITIES

1. Advocate for patients regarding complaints or billing issues, while following established policies and procedures, by responding to patient calls/inquiries, reviewing information provided by patient, and asking pertinent follow-up questions to obtain missing information.

2. Provide account resolution, within HFMA Patient Friendly requirement (i.e., 48 hours), by assessing the service provided, reviewing the billing system for errors and/or various 3 rd party payers' contracts for terms that will assist in answering/resolving the patient's issue. Provide the patient with explanation or address any errors found. Document all activity on patient accounts (i.e., conversations, actions taken, follow-up needed) in the system, according to industry standards.

3. Identify any issues, such as a breakdown in the process that causes delay in payment, or repetitive errors that may be encountered during claim submission and processing and provide feedback to management. Collaborate with manager and CBO staff to resolve these issues in order to improve processes, increase accuracy, create efficiencies, and achieve department goals.

4. Ensure compliance with all state and federal billing regulations by reporting suspected compliance issues to Supervisor/Manager or Compliance Manager.

5. Complete the follow-up of claims when an error is identified according to the CBO guidelines for account follow-up goals. Submit the necessary re-bill for the claim, monitor and expedite by contacting the assigned payor representatives to ensure the re-bill has been received, re-processed, and payment has been made. Keep the patient informed of the steps being taken and the status of the claim.

6. Assist patient in setting up mutually agreeable payment arrangements by explaining the options (i.e., increased future payments, partial lump sum payment with delayed payments for the remaining balance) available to them according to our policy. Refer patient to Financial Assistance/Follow-up Rep to complete the process.

7. Initiate the Financial Assistance process in the event patients communicate financial difficulty in making agreed-to payments, in accordance with Presence' Health's Financial Assistance Policy. Explain the process to the patient and why the requested information is necessary, mail the application to them and follow-up with the patient to ensure that they fill out the application completely and within the specified timeframe. Respond to patient's questions to assist them through the process. Refer patient to Financial Assistance/Follow-up Rep to complete the process.

8. Review payment denials and discrepancies identified through EOB, Remittance Advices or Payor correspondence, research the respective insurance billing regulations and guidelines and, identify and take the appropriate action to correct these accounts. Explain the reason for the payment denial (i.e., not a covered benefit, experimental procedure, etc.) to the patient and provide them with a written description of this exclusion in their policy.

Education and/or Experience

High School diploma or GED

Three years in patient accounting/business office environment, specifically billing and/or collections in the assigned insurance area

PREFERRED: Two-year higher education or Associates Degree in finance, accounting or business

Computer Skills

Experience with computers, adding machine and normal office equipment (telephone, fax, copier, voice mail, etc.)

Microsoft Office

Meditech patient accounting system experience preferred

Business Unit: Corporate (LRHC and LPH)

COMPANY OVERVIEW:

EOE of Minorities/Females/Vets/Disability