Catholic Health Services of Long Island (CHS) is an integrated health care delivery system with some of the region's finest health and human services agencies. CHS includes six hospitals, three skilled nursing facilities, a regional home nursing service, hospice and a multiservice, community-based agency for persons with special needs. Under the sponsorship of the Diocese of Rockville Centre, CHS serves hundreds of thousands of Long Islanders each year, providing care that extends from the beginning of life to helping people live their final years in comfort, grace and dignity.
Under the direction of the Hospital Revenue Recovery Center (RRC) Manager, the RRC Follow-Up Representative is responsible to review all assigned third-party and/ or patient accounts, ensure that responsible payers are billed and remit payment in a timely manner, and to document account status and actions appropriately in the patient accounting system(s).
Reviews aged trial balances and work-queues to determine accounts requiring action. In accordance with department policies and procedures, performs such actions as initiating phone calls and website inquiries, drafting and submitting letters/ appeals, attending payer meetings in order to move accounts forward in the follow up and payment cycle.
Assesses payments and adjustments for accuracy and timeliness. Interprets Managed Care/ contracts to establish accuracy the A/R. Reviews regulatory updates to understand impacts to reimbursement from federal and state payers. Corrects transactions as necessary in addition to reporting and documenting on-going issues to management.
Determines the reason for a denial and follows-up / appeals accordingly. Investigates under / over payments and takes appropriate actions to resolve the account in accordance with departmental procedures
Transfers balances to next responsible parties as appropriate
Ensures claims meet payer requirements and are compliant; resolves claim and billing errors as necessary. Submits and resubmits claims electronically or by paper as necessary.
Ensures claims are crossed over to secondary and tertiary payers and reports any delays in unbilled claims
Responsible for meeting and/ or exceeding productivity and quality standards as set forth in the department's policies and procedures.
Is aware of timely filing guidelines for all payers; prioritizes work based on these timelines to ensure claims are being followed up accordingly and financial losses are minimized
Performs root cause analysis with a solutions focus; tracks trends and escalates carrier or revenue cycle system issues to Manager
Participates in audits as directed by leadership; collects and assembles financial documents related to billing and payment to substantiate services and reimbursement
Runs and works reports as directed by the Manager for resolution of A/R, claims, and projects
Regularly meets with Manager to discuss and resolve reimbursement issues and billing obstacles
High School diploma or equivalent required plus one year of hospital billing experience, including third party follow-up and customer service related duties.
Associate's degree with a minimum of two years' experience in hospital billing or a related field or the equivalent combination of education and experience preferred
Establishes and demonstrates competency in accounts receivable systems and associated applications
Knowledge of third party operations
Knowledge of CPT, ICD9 utilized in medical billing and medical billing terminology
Fluency with automated patient accounting systems
Excellent customer service skills to communicate effectively with insurance carriers, patients, and colleagues
Excellent communication skills including oral comprehension/ expression and written correspondence
Ability to work independently, exercising good judgment, and multi-task in a high stress, fast-paced service environment with patients, patient's family, insurance carriers, and leadership
Ability to maintain professional conduct and good working relationships with staff, management, and payers
Detail-oriented with good analytical problem-solving skills
Ability to comply with procedural guidelines and instructions and to solicit assistance when situations arise that deviate from the usual and customary
Industry certification (AHIMA, HFMA, AAPC, etc.) preferred
EMR experience (Epic preferred)
Microsoft Office proficiency
At Catholic Health Services of Long Island your well-being comes first, with comprehensive compensation and benefits; our offerings go beyond the basics. In addition to multiple medical plans, life insurance, generous paid time off and flexible spending accounts, we also offer substantial tuition reimbursement, an employer funded pension plan and several savings plan options for your future.
St. Catherine Of Siena