Description
JOB PURPOSE OR MISSION: To analyze and follow up outstanding account balances and establishing acceptable payment arrangements.
PERFORMANCE CRITERIA
CRITERIA A: Everyday Excellence Values - Employee demonstrates Everyday Excellence values in the day-to-day performance of their job.
PERFORMANCE STANDARDS:
• Demonstrates courtesy and caring to each other, patients and their families, physicians, and the community.
• Takes initiative in living our Everyday Excellence values and vital signs.
• Takes initiative in identifying customer needs before the customer asks.
• Participates in teamwork willingly and with enthusiasm.
• Demonstrates respect for the dignity and privacy needs of customers through personal action and attention to the environment of care.
• Keeps customers informed, answers customer questions and anticipates information needs of customers.
CRITERIA B: Corporate Compliance - Employee demonstrates commitment to the Code of Conduct, Conflict of Interest Guidelines and the GHS Corporate Compliance Guidelines.
PERFORMANCE STANDARDS
• Practices diligence in fulfilling the regulatory and legal requirements of the position and department.
• Maintains accurate and reliable patient/organizational records.
• Maintains professional relationships with appropriate officials; communicates honesty and completely; behaves in a fair and nondiscriminatory manner in all professional contacts.
CRITERIA C: Personal Achievement - Employee demonstrates initiative in achieving work goals and meeting personal objectives.
PERFORMANCE STANDARDS
• Uses accepted procedures and practices to complete assignments. Uses creative and proactive solutions to achieve objectives even when workload and demands are high.
• Adheres to high moral principles of honesty, loyalty, sincerity, and fairness.
• Upholds the ethical standards of the organization.
CRITERIA D: Performance Improvement - Employee actively participates in Performance Improvement activities and incorporates quality improvement standards in his/her job performance.
PERFORMANCE STANDARDS
• Optimizes talents, skills, and abilities in achieving excellence in meeting and exceeding customer expectations.
• Initiates or redesigns to continuously improve work processes.
• Contributes ideas and suggestions to improve approaches to work processes.
• Willingly participates in organization and/or department quality initiatives.
CRITERIA E: Cost Management - Employee demonstrates effective cost management practices.
PERFORMANCE STANDARDS
• Effectively manages time and resources
• Makes conscious effort to effectively utilize the resources of the organization — material, human, and financial.
• Consistently looks for and uses resource saving processes
CRITERIA F: Patient & Employee Safety - Employee actively participates in and demonstrates effective patient and employee safety practices.
PERFORMANCE STANDARDS
• Employee effectively communicates, demonstrates, coordinates and emphasizes patient and employee safety.
• Employee proactively reports errors, potential errors, injuries or potential injuries.
• Employee demonstrates departmental specific patient and employee safety standards at all times.
• Employee demonstrates the use of proper safety techniques, equipment and devices and follows safety policies, procedures and plans.
JOB FUNCTIONS
ESSENTIAL JOB FUNCTIONS include, but are not limited to:
1. Processes claims populating into Ambulatory Claims Manager (ACM)
PERFORMANCE STANDARDS:
• Resolve Invalid and Rejected Claims populating into the list within 5 days.
• Documents the system with notes on current status received and takes appropriate action.
• Refers delinquent responses and new denials to management.
2. Processes hard copy claims for payment
PERFORMANCE STANDARDS:
• Obtains Explanation of Benefits (EOBs) for coordination of coverage to attach to Subsequent claims to Secondary and Tertiary carriers.
• Reviews claim for timely filing guidelines, fee schedule reimbursement, etc prior to mailing claims
• Refers any issues to management.
3. Maintains Practice Responses to communications
• Creates and responds to RAI (Request for Additional Information) and/or Spreadsheet
• Monitors any lack of responses
• Refers any issues to management
4. Special projects
PERFORMANCE STANDARDS:
• Receives and resolves “unable to bill” claims by reviewing the system for copy of insurance card, correct address, policy number and phone number of insurance carrier for Hospitalist Group
• Investigates any reports delivered by management to monitor denials
5. Performs all other duties as assigned.
EXPERIENCE REQUIREMENTS
Prior experience in all phases of Business Office operations and Insurance Collections
EDUCATIONAL REQUIREMENTS
High School Diploma or GED preferred.
SPECIAL SKILL, LICENSE AND KNOWLEDGE REQUIREMENTS
Must have excellent understanding and knowledge of Commercial Insurance.
HIPAA REQUIREMENTS:
Maintains knowledge of and adherence to all applicable HIPAA regulations appropriate to Job Position including but not limited to: paper medical record without limitation, patient demographics, lab results, patient financial and 3rd party billing information, patients related complaints, information related to patient location.
SAFETY REQUIREMENTS:
Maintains knowledge of and adherence to all applicable safety practices appropriate to Job Position including but not limited to: incident reporting, exposure control plan, hand washing for all age groups.
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