Requisition ID: 59382

Location: Senior Services Corporate

Location Address:
18927 Hickory Creek Place, Mokena, IL 60448-8652 United States (US)

Daily Hours: 8
Standard Hours: 40
Employment Status: Full-time
Employment Type: Regular
Shift: Day
FLSA: N

SUMMARY

Responsible for the preparation and filing of claims to various third party payers for services. Facilitates payment for services rendered to patients by Presence Health in accordance with policies and procedures.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Reviews the patient account demographic and insurance information for completeness and accuracy, edits data in computer system.

Reviews computer generated bills and claims for accuracy, initiates corrections to data. Counsels patients and/or responsible party regarding resolution of bill.

Bills patients, insurance companies, or other third party payers by mail, electronic transmission, or by courier. Initiates phone contact with insurance companies or other third party payers to facilitate payment of accounts.

Reviews computer generated report, identifying errors, and corrects errors. Monitors various system-generated reports to identify accounts requiring additional follow-up and initiates follow-up.

Review reports identifying unpaid claims, and perform necessary follow-up to affect payment of claim. Evaluate patient's financial status, initiate follow up with various state, federal and hospital based assistance programs.

Familiar with Florida shared system for claim corrections, submissions, and additional document requests.

Prepare and mail correspondence to patients regarding account status. Documents collection efforts on patient's account in computerized AR system, in clear, concise and unbiased manner.

Knowledge of Medicare APC

Medicare inpatient and outpatient billing processes.

Knowledge of CCI and OCE edits.

Maintain up-to-date knowledge of billing procedures and regulations by attending department meetings and inservices, conferences, seminars, and by reading trade journals.

Make copies; fax bills and claims to requesting parties, and filing/retrieving paperwork.

Maintains high quality standards (timely and accurate processing of information) and positive employee relations. Identifies and resolves complaints and concerns in a timely and appropriate manner. If the complaint cannot be resolved, the complaint is forwarded to supervisor.

Will comply with all aspects of the Presence Health Corporate Responsibility Plan to include the immediate reporting of any known or suspected illegal or unethical behaviors, criminal conduct or patient/employee safety violations or issues.

Communicates in a positive and cooperative manner with management, supervisory staff, medical staff, co-workers, patients, families and other health care personnel when providing information, seeking assistance and clarification and resolving problems. Has a positive, high quality contact with outside agencies, i.e. collection agencies, law firms, employers.

Maintains high level of knowledge of the contractual agreements responsible for. Maintains up to date knowledge of the range of assistance programs available to patients.

Review aged accounts for appropriateness of collection efforts. Process accounts in accordance with bad debt policies and procedures for in house and outside collection agency placement.

QUALIFICATIONS

Requires a team oriented self-motivated professional with the ability to communicate effectively the values, philosophy, and culture of Presence Health as they relate to organizational performance. Identifies with, shares in, and exhibits a commitment to the mission, vision, values, and principles of total quality management. Possess an ability to communicate in both verbal and written form with a broad cross section of management and support personnel throughout the division. Demonstrates ability to accomplish results through people from many different disciplines with varying degrees of technical experience.

Education and/or Experience

• High school education.
• Minimum 1 year Medicare billing experience or similar knowledge. Familiar with Florida shared system for claim corrections, submissions and additional document request.
• Knowledge of Medicare APC, Medicare inpatient and outpatient billing processes.
• Knowledge of CCI and OCE edits.

Application submittal is acknowledgement that pre-employment screening will be conducted on all potential hires post-offer. Applicants are entitled to a copy of the background check report and have the right to challenge its accuracy and completeness. If the applicant is covered by the Illinois Health Care Worker Background Check Act, and the applicant's record indicates a conviction, he or she may request a waiver from the Illinois Department of Public Health.