Processes and follows up on all nongovernment variances inclusive of debits and credits.. Handles inquiries from patients, third parties and agencies regarding any aspect of services received or status of account. Reviews and completes follow through on remittances for allowances and rejections. Updates receivable system with any new, corrected or pertinent information in relation to resolution of receivable accounts.
It is imperative that all care that is provided to the patient is accurately reflected on the bill and is in compliance with regulations pertaining to facility billing and patient care. It is imperative that we actively work the AR to ensure that we are reimbursed appropriately for the services rendered and to ensure that we don't receive erroneous denials. The staff ensures that the accounts are paid accurately as well as reviews the aged AR to make sure all revenue is captured and the patients are not erroneously held liable for charges.
Major Responsibilities:
1. Ensure prompt, accurate, and compliant billing and payments for all third party payer patient claims.
2. Accurate billing and/or follow-up of patient accounts according to established departmental guidelines based upon regulation requirements for specific insurance carriers.
3. Monitors and reconciles daily reports as well as assigned worklist for appropriate account resolution inclusive to credit, debit and adjustments.
4. Documentation of all action taken on an account.
5. Completes all projects as assigned.
6. Maintains department standards of productivity.
7. Accurate analysis of variances and contracts to recover underpayments/resolve outstanding accounts receivable.
8. Analyze all accounts and contacts appropriate party of unpaid accounts and updates all accounts appropriately.
9. Facilitates patients' and departments in the health system by providing excellent customer service skills and serving as an advocate for the patient in explaining third party payer coverage's, referral and pre-certification requirements.
10. Providing timely and accurate information regarding patient data/status to other health system departments, physicians, physician office staffs and other publics while insuring patient confidentiality is not breached.
11. Performs other related duties as assigned or requested to maintain a high level of service.
12. Demonstrates professional work behavior by following Service Standards and Success factors.
13. Trends variances by payer to present to management during team meetings.
14. Reviews proration to determine if contract loaded inappropriately.
15. Ability to analyze and identify variances to determine if payer or hospital has misinterpreted contract terminology.
Requirements:
Two years college, and/or two years prior equivalent experience in a Hospital setting with experience in revenue cycle. Computer literacy in PC environment is required with strong organizational, analytical, interpersonal and communication skills. Familiar with hospital billing and coding.
About Stamford Health
Stamford Health is a non-profit independent health care system with more than 3,800 employees committed to caring for the community through a wide range of high-quality health and wellness services. Patients and their families receive expert, compassionate care through the system’s 305-bed Stamford Hospital; Stamford Health Medical Group, with more than 40 offices in lower Fairfield County offering primary and specialty care; a growing number of ambulatory locations across the region; and support through the Stamford Hospital Foundation.
Stamford Health is known for its expert, person-centered care through its many recognitions and partnerships. U.S. News & World Report has recognized Stamford Hospital as a High-Performing Hospital. The Centers for Medicare and Medicaid Services (CMS) rated Stamford Hospital as a five-star hospital for Overall Quality and The Leapfrog Group awarded Stamford Hospital an “A” for patient safety. The American Nurses Credentialing Center has granted Stamford Hospital Magnet Status, which recognizes superior patient care with the highest level of safety, quality, and patient satisfaction. Stamford Health is Planetree Gold-Certified for Excellence in Person-Centered Care and is a Certified™ Great Place to Work.
Stamford Health is a major teaching affiliate of the Columbia University Vagelos College of Physicians and Surgeons and has recently expanded its relationship with Columbia to offer treatment and expertise from Columbia University Irving Medical Center’s nationally recognized heart surgeons. Stamford Health and Hospital for Special Surgery (HSS) have created a premier center for specialty orthopedic care right in Stamford, Connecticut. Additionally, in 2020 Stamford Health’s Carl & Dorothy Bennett Cancer Center entered into an expanded collaboration with Dana-Farber Brigham Cancer Center.
Dedicated to being the community’s most trusted health care partner, Stamford Health puts patients first to build long-lasting relationships. For more information, visit StamfordHealth.org. Like us on Facebook and follow us on Twitter, Instagram, YouTube, and LinkedIn.