SUMMARY:
Ensures the efficient handling of all insurance billing, follow up and collection activities. Communicates with insurance companies and state agencies. Possesses strong knowledge of payer contracts and demonstrates complete understanding of payer billing requirements to ensure timely and accurate payment. Completes reconciliation and billing of accounts making independent decisions based on payer, coding and billing guidelines.
ESSENTIAL FUNCTIONS:
Exhibits excellence in customer service through appropriate attitude and interaction with all customers, insurance plans, patients, visitors and staff. Maintains and fosters effective public relations with patients and public.
Adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication.
Assists management in maintaining or reducing account receivable (AR) days to meet industry standards and improve organizational cash flows.
Ensures patient accounts are billed and followed up on timely in a complete and accurate manner in accordance with payer contracts or guidelines.
Provides information regarding patient accounts in response to inquiries, safeguarding confidential information in verbal replies and correspondence.
Prepares and enters contractual write offs as identified.
Serves as information resource to patients and hospital staff regarding insurance claims.
Provides routine internal and external interface with internal and external department staff and insurance payers, in order to resolve insurance related accounts.
Assists with problem solving, inquiries, and customer interaction to ensure positive results.
Analyzes patient accounts, reviews explanation of benefit and payer remits. Analyzes and processes contractual write offs as needed
Trains and assists in the implementation of new software programs/systems, system upgrades and related technologies.
Responds to insurance inquiries/requests as received either by mail or electronically.
Ensures all billing edits are completed daily for claim submission.
Adheres to TMCH organizational and department-specific safety and confidentiality policies and standards.
Performs related duties as assigned.
EDUCATION: High School diploma or General Education Degree (GED); or an equivalent combination of relevant education and experience.
EXPERIENCE: Three (3) years of related experience such as medical billing, medical insurance follow up in a physician or hospital setting.
LICENSURE OR CERTIFICATION: None required.
KNOWLEDGE, SKILLS AND ABILITIES: