Job ID 21000KUI
Available Openings 3
PURPOSE AND SCOPE:
Supports FMCNA's mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements.
Under direct supervision, enters payment, adjustments and denial transactions received for FVC Center locations via either paper Explanation of Benefits (EOB) or electronic remittance files ensuring the applicable billing deadlines are met. Reconciles payment entries with the daily bank deposits for the appropriate FVC locations.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Under supervision, utilizes the appropriate systems and procedures to process payments, adjustments and denials for FVC Centers. Ensures payment, adjustment and denial transactions are accurately posted and reconciled according to department and company specifications and in compliance with regulatory requirements. Escalates more complex transactions and issues to Team Lead or supervisor as appropriate.
Receives the electronic deposit confirmation via email from the bank for the FVC center location, downloads the images of corresponding paper Explanation of Benefits (EOB's) and prints electronic Remittance Advice (RA) reports from the electronic data interchange vendor (Navicure).
- Totals transactions on EOB's and RA's and verifies that balances total the respective deposit.
- Creates a batch by payer and/or deposit date and totals each batch.
- Applies the batched transactions to the appropriate accounts in the appropriate medical billing software application (Medical Manager or Imagine).
- Verifies that the applied transactions reconcile to the batch totals.
- Generates a payment application report and attaches to the batches posted for the day.
- Posts the non-payment transactions (including adjustments and denials) to the appropriate accounts in the medical billing software application.
- Closes all medical billing application batches on a daily basis
- Calculates sum totals of checks remitted on behalf of FVC centers, completes a bank deposit slip and attaches to the checks retaining a copy of the deposit slip. Delivers the original deposit slip and the checks to the Accounting department to be deposited. Batches any accompanying EOB's and enters the specified transactions according to the established department procedure.
Maintains and updates the appropriate accounts on the Denial Batch Manager log. Updated information reviewed by the A/R Representative working on the denied and under/overpaid claims posted the prior business day.
- Adds accounts denied payment by the insurance carrier from the EOB's/RA's posted the current business day.
- Reviews the Reimbursement Log to determine if claims are being reimbursed according to the payer contract or government published fee schedule.
- Accounts with discrepancies between the payment and the fee listed on the reimbursement log are added to the Denial Batch Manager log. Payments less than the government published fee schedule are addressed by the A/R Representative.
- If payment exceeds the government published fee schedule, the payment poster sends a voluntary refund request to Medicare or Medicaid via mail, fax or telephone, as the specific intermediary or State Agency requires. CMS (Medicare/Medicaid) refunds are to be completed within 30 days of overpayment. Medical billing application is updated with details regarding status and action completed to initiate government refunds.
Reconciles deposit totals for each FVC location to the transactions posted month-to-date.
- Generates a Cash Collections report from medical billing application indicating the payments entered for each FVC location for a specified month.
- Compares Cash Collections and month-to-date Deposit Log totals researching and escalating discrepancies as needed.
- May provide assistance to junior staff with more general support tasks that require a better understanding of functions, as directed by immediate supervisor.
- May refer to senior staff for assistance with higher level problems that may arise.
- Escalates issues to supervisor for resolution, as deemed necessary.
- Assist with various projects as assigned by direct supervisor.
- Other duties as assigned.
Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.
PHYSICAL DEMANDS AND WORKING CONDITIONS:
- The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Prolonged sitting at a computer work station. Extensive use of telephone and ability to maintain a focused train of thought while multitasking in the process of investigating billing issues. Able to concentrate on detail oriented data for prolonged period of time. Able to adjust routine to accommodate departmental needs and goals; must be able to lift light objects; retrieve files from cabinets which may involve upward or downward physical mobility; can focus on computer monitor for prolonged periods and clearly see data in paper form with small font printing; can effectively communicate via telephone.
- High School Diploma required
EXPERIENCE AND REQUIRED SKILLS:
- 1 – 2 years' related experience. Medical billing or collections experience required.
- Strong mathematical aptitude. Payment applications experience in a healthcare environment is helpful.
- Strong knowledge of Windows-based software applications. (E.g. Word, Excel…).
- Excellent written and verbal communication skills.
- Strong organizational and time-management skills.
- Attention to detail.
- Positive attitude and team-oriented approach.
EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity
Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.
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