SUMMARY:

Performs all functions related to the timely follow-up and collection of third party patient accounts, in accordance with State and Federal rules and regulations and hospital policy and procedure.

REQUIREMENTS:

• High School Diploma
  Work Schedule:
  8AM - 5PM Monday-Friday

• Reviews reports from insurance companies/government payers for possibility of resubmission
• Resubmits, bills patient, or writes-off as appropriate
• Files appeals on rejected services within filing deadline
• Follows-up on unpaid third party accounts by telephone and/or tracer within time frames and guidelines set forth in hospital policies and procedures
• Prepares rebilling as necessary
• Reviews correspondence received from third party carriers, etc and responds before insurance company deadlines
• Makes request for medical records when necessary
• Reviews payments on accounts for accuracy
• Contacts insurance carriers if payment is less than quoted benefits to resolve balance responsibility
• Calculates or recalculates contractual allowances and corrects as necessary
• Corrects Managed Care discounts, employee discounts, etc. as necessary after recalculating discount
• Documents all insurance activity in computer system
• Demonstrates competence to perform assigned responsibilities in a manner that meets the population-specific and developmental needs of members served by the department
• Appropriately adapts assigned assessment, treatment, and/or service methods to accommodate the unique physical, psychosocial, cultural, age specific and other developmental needs of each member served