PFS Associate Iii- Tricare Collections

Trinity Mother Frances Health System Irving , TX 75061

Posted 5 months ago

Responsible for the duties and services that are of a support nature to the RCBS High Performance Work Teams. Ensures that all processes are performed in a timely and efficient manner. Performs assigned duties such as, customer service, data entry and reviewing of claims for proper billing/collections/validations. Responsible for performing billing, collections and reimbursement services of claims and duties to hospitals supported by the RCBS. In doing so, ensures that all claims billed and collected meets all government mandated procedures for Integrity and Compliance. Performs billing, collections and reimbursement services in a prompt and efficient manner. Provides thorough, courteous and professional assistance to patients, physician offices, insurance companies and other clients on an as needed basis while maintaining strictest confidence. Documents, forwards, resolves incoming mail and correspondence. 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 that RCBS would not have knowledge of. Ensures all Compliance errors are reported to the Director and maintain records and files of documentation supporting bill changes that are directed by Director and/or Integrity Officer. Responsible to ensure successful implementation of Governmental Regulatory Billing changes, including but not limited to Medicare OPPS effective August 1, 2000.

MAJOR RESPONSIBILITIES

  • Ensure daily productivity standards are met.

  • Log IPOs as issues arise and report during shift briefing

  • Maintains an active working knowledge of all Governmental Mandated Regulations as it pertains to claims submission. Responsible to perform the necessary research in order to determine proper governmental requirements prior to claims submission.

  • Responsible to contact Clinical departments and Medical Records in order to obtain information relevant to erred claims as possible Integrity issues. Works with Departments for proper resolution of erred claims. Maintains logs of Integrity related governmental claims and reports to Management weekly.

  • Reviews and resolves claims that are suspended daily in electronic billing terminals in accordance with procedure.

  • Responsible for working claims generated reports, providing proper documentation and making necessary corrections within specified times.

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

  • Reviews and resolves claims that are suspended daily in electronic billing files in accordance with procedure

  • Ensures all correspondence, rejected claims and returned mail is worked within 48 hours of receipt (allowing for weekends and holidays). Ensures business service requests are worked and documented within 24 hours of receipt.

  • 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

  • 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. Stays abreast of all government changes.

  • 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.

Billing

  • Review UB 04's for possible errors prior to submission to ensure accurate claims are being submitted by 3:00pm daily

  • Submit corrected claims along with rebills to the payor daily

  • Contacts other departments for necessary information to correctly bill claims as needed

  • Reviews and rebills claims to the Rejection and HUB reports in SSI daily

  • Works Meditech billers queue daily

  • Ensure split bill claims are billed accurately with the proper charges on the claim.

Collections

  • Collect balances due from payors

  • Maintain an active knowledge of all collection requirements by payors

  • Ensures daily billing and re-bill files are cleared in accordance with documented procedures; daily EOB's, reports, correspondence, and appeal files are cleared within 48 hours of receipt.

  • Works collector queue daily

  • Works correspsondence and return mail.

Validations

  • Ensure proper reimbursement for all services and to ensure all appeals are filed timely

  • Review accounts and determine appropriate follow up activities utilizing Six Sigma Practices

  • Identify under and overpayments and take appropriate actions to resolve accounts

  • Validate commercial insurance claims to ensure the claims are paid according to the contract

  • Direct knowledge using Meditech and CollectLogix software

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

  • HS Diploma or equivalency required

  • Post HS education preferred

  • Must have minimum of 2 years' experience with Commercial insurance billing, collections, payment and reimbursement verification and/or refunds.

  • Understanding of alternative

Business Office financial resources and the ability to provide information and/or recommendations related to these sources of recovery are preferred.

  • General hospital A/R accounts knowledge is required.

  • College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.

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PFS Associate Iii- Tricare Collections

Trinity Mother Frances Health System