Insurance Team Specialist

Dimensions Health Care Hyattsville, MD
Overview

Performs all phases of patient accounting functions to include insurance verification, billing, follow-up, and collections of accounts receivables to meet monthly budgeted cash collection projections of assigned financial class team(s).

Responsibilities

* Implements appropriate account processing based on established policies and procedures for billing, rebilling, write-offs (i.e., small balances, late charges, employee/VIP discounts, payor discounts, etc.), bad debt, etc.

* Utilizes patient accounting knowledge and day-to-day operational experience to constructively participate in various inter/intra-departmental meetings as requested. Applies critical thinking and good problem-solving skills to contribute to team and department-specific policy, procedure, and workflow development, evaluation, revision, and recommendation.

* Completes daily work to ensure that the assigned financial class team(s) = outstanding billing does not exceed two business days. Error rate not to exceed 3%. Returned claims for corrected information not to exceed 5% of volume of claims submitted for reimbursement. Workstation or assigned reports 98% completion within designated time frame. DNFB over five days not to exceed 3% for all assigned financial classes. Vouchers, third party payments (EOBs/EOPs), Mail, Correspondence, and other work items of assigned financial class team(s) are processed completely, accurately, and timely not to exceed a 3-5 day backlog. Cash collection to meet at least 95% of monthly budgeted cash projections.

* Accurately completes, processes, or takes appropriate action on a minimum of 75 accounts per day (to include, but not limited to, billing, follow-up, vouchers, EOBs/EOPs, mail, reports, etc.), unless otherwise approved by the immediate Team Leader(s) or Manager.

* Maintains appropriate account level reviews to ensure timely account processing. Executes aggressive, accurate and timely follow-up on accounts according to established policies and procedures for assigned financial class team(s). Completes follow-up action on at least 98% of all accounts assigned by Team Leader(s) or Manager(s) within designated time frames. Completes follow-up action on at least 98% of all AR accounts as assigned within 30-45 days since discharge. Makes at least two or more follow-up attempts on accounts prior to aging of accounts to 60 days. Informs and coordinates with Team Leader(s) to address problems with accounts to ensure reimbursement or final disposition of accounts prior to aging to 65 days.

* Enters complete and accurate comments on assigned accounts in SMS denoting all follow-up and account processing activity. Enters appropriate activity codes and follows proper procedure in entering comments, transferring accounts to other staff for review/action, requesting medical records and/or diagnosis or procedure coding, and entering future follow-up dates to ensure continued and appropriate follow-up action on account until reimbursement is obtained.

* Assists in the identification of system errors (from the Patient Accounting Management System - SMS and various electronic billing systems.) Assists in the correction of system errors and implementation of system edits as requested. Identifies, corrects, and rebills at least 98% of all rejections received from daily electronic billing claims processing reports within 2 days of the dated report. Accurately completes all (100%) electronic billing activities on a daily basis in accordance with established requirements and workflow policies and procedures (i.e., daily transmission by Noon, running reports, checking mail, notices, deliverables, etc.) Notifies Team Leader(s) of all system or transmission problems immediately and assists in problem resolution as requested.

* Completes all daily, weekly, and monthly reports as established for assigned financial team(s). Accurately completes and submits daily productivity reports, billing batch sheets, etc. to Team Leader by the end of each workday. (No more than 2 incidents of incomplete, inaccurate, or late/missing completed productivity reports, billing batch sheets, etc.)

* Runs Intellect reports to trouble-shoot accounts and identify trends, issues, and system/process problems for assigned payor(s) and financial class team(s) as requested. Prepares and completes statistical and detail analyses reports for assigned financial class team(s) within designated time frames as requested to meet daily, monthly, or annual reporting requirements.

Qualifications

* High school graduate or GED, is required.

* Requires knowledge of third party insurances.

* Knowledge of pre-certification and verification requirements.

* Knowledge of state and federal regulation is preferred.

* One year hospital enviroment (patient accounting), one year of customer service and use of CRT is required.

* Three years of patient accounting and use of collectors work stations is perferred.

* Position requires ability to speak, read , write, comprehend and spell in English at at 12 grade level.

* Must be able to easily communicate with clinical personnel and lay persons.