Insurance Collections Specialist- Managed Medicare

Trinity Mother Frances Health System Irving , TX 75061

Posted 3 months ago

Responsible for the duties and services that are of a support nature to the Patient Financial Services team in the following duties: Ensures that all processes are performed in a timely and efficient manner by reviewing account detail to ensure accuracy in cash posting, data entry and reviewing of claims for proper billing/collections. In doing so, ensures that all claims billed and collected meets all government-mandated procedures for Integrity and Compliance. Performs insurance collections and reviews reimbursement in a prompt and efficient manner. Provides thorough, courteous and professional assistance to all associated departments within Christus, insurance companies and other clients on an as needed basis while maintaining strictest confidence. Documents, forwards, resolves incoming mail and correspondence in a timely, accurate manner. Demonstrates a level of accountability to ensure data and codes are not changed on claims prior to submission if related to diagnosis, charge and/or other clinical type data. Ensures all Compliance errors are reported to the manager or Compliance Director.

MAJOR RESPONSIBILITIES

  • Ensures daily productivity standards are met and daily Correspondence are cleared within 48 hours of due date (allowing for weekends and holidays).

  • Log and/or escalate issues that arise to leadership as they arise to ensure resolution

  • Maintains an active working knowledge of all Governmental Mandated Regulations, timely filing and appeal follow up. Responsible to perform the necessary research in order to determine proper governmental reimbursement has been received.

  • Responsible to open Work Queues to Clinical departments, Medical Records, Admitting, etc., in order to obtain information relevant to erred claims to obtain resolution. Works with Departments for proper resolution of erred claims.

  • Ensures quality standards are met and proper documentation regarding patient accounting records

  • Ensures all correspondence, rejected claims and returned mail is worked in a timely manner. Notifies leadership in the event work will not be completed in time so it can be reassigned if needed.

  • Identifies and forwards proper account denial information to the designated departmental liaison. Dedicates efforts to ensure a proper denial resolution and timely turnaround.

  • Monitors and communicates errors generated by other departments, communicating trends to leadership

  • Maintains an active working knowledge of all billing and reimbursement requirements by Payer. Continuously receives updates and information regarding changes and newly revised billing and reimbursement practices and ensures compliance.

  • Provides continuous updates and information to Business Office Management regarding ongoing errors, payer related issues, registration issues and other controllable QA related activities affecting reimbursement and payment methodology.

  • Notifies leadership if calculated contractuals are inaccurate.

  • Works collaboratively with team members to assist in keeping workload evenly distributed.

  • Ensures quality standards are met in clerical services performed in accordance with Integrity and Compliance guidelines.

  • Review predetermined criteria to process patient and insurance refund request.

Collections

  • Collect balances due from payors by working Collector Work Queues and Collector Work Lists per the prescribed team workflow.

  • Maintain an active knowledge of all collection requirements by payors

  • Ensures claims are re-billed if necessary after contacting payer for claim status and verification of pertinent patient and mission fields were transmitted accurately.

  • Initiate claim appeals, requests for medical records, and other tasks necessary to resolve the claim using the One Touch Method.

  • Works correspondence, rejected claim and returned mail as applicable.

Validations

  • Ensure proper reimbursement for all services and to ensure all appeals are filed timely. Escalates accounts appropriately to Cash if payment is not posted correctly.

  • Review accounts and determine appropriate follow up activities utilizing One Touch Method.

  • Review Medicare inpatient, SNF, Outpatient pricer to ensure reimbursement is accurate and to identify under and overpayments and take appropriate actions to resolve accounts

  • Validate insurance claim payments to ensure the claims are paid according to the contract. Understand how to recognize an overpayment.

  • Direct knowledge using Meditech, Connance and On Base software to review and ensure proper billing and reimbursement.

  • Monitor and communicate errors generated by other groups and evaluate for trends to leadership

  • HS Diploma or equivalency required

  • Post HS education preferred

  • Must have minimum of 3 years' experience with Medicare, Medicaid or Commercial insurance collections. Billing, payment and reimbursement verification is also a plus

  • Understanding of Insurance collections process and language

  • Understanding of how and when to bill Medicare as secondary, how to read the information in the Common Working File -- HMO coverage, Hospice dates, COB screens etc. is a plus

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Insurance Collections Specialist- Managed Medicare

Trinity Mother Frances Health System