Billing & Collection Specialist

Hudson Regional Hospital•Clifton, NJ

About The Position

POSITION TITLE : AR and Collection Rep Commercial Insurance Managed Care REPORTS TO: Department Director DEPARTMENT: Billing & Collections FLSA STATUS: NON EXEMPT Job Specific Competencies: Follow-up on all claims from billing through final resolution for commercial insurance and managed care claims. Perform necessary correction to errors received from daily electronic billing reports, paper claim submissions and third party confirmation reports. Where applicable, make necessary corrections in the billing system. Expedite payment of outstanding accounts through regularly scheduled follow up activity. Review system generated reports to identify accounts requiring research based on guidelines established by department. Determine appropriate action to be taken for resolution of accounts, securing prompt and accurate payment. Documents result in appropriate system(s) and Log. Alert Supervisor and/or Manager of non-payment trends. Research partial payments and determine if appropriate contractual allowance was calculated at time of billing based on reimbursement rules. Initiate corrective action for resolution of account, including collaboration with clinical department. Document results in appropriate system(s) or Log. Alert Supervisor and/or Manager of trends with miscalculation of contractual allowances Research rejected and/or denied services. Determine corrective action to be taken. Complete corrective action, utilizing departmental procedures, policies, and document results in appropriate system(s) and Log. Alert Supervisor and/or Manager of non-payment trends Complete productivity reports and forward to Supervisor per established time frame Support customer service and performance improvement goals of the department; collaborate with other staff, within and outside the Department, to develop means of enhancing patient care and service Maintain standards of confidentiality Must possess ability to interact with variety of individuals as a problem-solver and have very good verbal and written communication skills. Strong analytical and organizational skills essential. Demonstrates excellent customer service skills when responding to incoming or outgoing calls in a most courteous manner providing clear and appropriate information as needed. Exercises good judgment towards account resolution and documents all activity on account in a clear, accurate and consistent manner utilizing appropriate system. Resolves credit balances in accordance to departmental policy and procedure. Maintains, process and log in AR records all requests for MR Is knowledgeable of and adheres to all hospital policies and procedures including but not limited to: Attendance Management: Reports to work on time; is flexible when staffing needs warrant change; requests time off in a timely manner; consistently utilizes time clocks to document in and out shifts. Rules of Conduct: Respects the rights and property of others; does not engage in Harassment or Violence in the Workplace. HIPPA: Maintains confidentiality of patients, staff and visitors at all times. Dress Code: Complies with dress code policy and wears ID at all times. Successfully completed previous year’s goals or performance improvement plan. Performs other duties as assigned. Customer Service Excellence Always introduces self to customers, patients and visitors professionally and courteously. Directs patients and visitors that appear to be lost; contributes positively to morale and demonstrates service excellence by being respectful, empathetic, helpful and attentive; response promptly to inquiries. Always treats all customers, co-workers with respect and professionalism per HR Rules of Conduct policy. Professional Development/Competency/Regulatory Compliance Is 100% compliant with 90 day and annual performance reviews of staff by due date. Participates in Performance Improvement (PI) projects as set forth by manager. Maintains current and valid credentials/license with relevant governing body and/or stays knowledgeable of all changes in federal, state, local and regulatory body laws, rules and regulations. Is compliant with HIPPA rules, regulations, and current patient safety standards. Working Conditions: An employee may be exposed to a variety of activities and conditions that place him/her at risk to exposure to certain diseases and circumstances Able to handle emergency or crisis situations May be exposed to blood borne pathogens and bodily fluids May be exposed to a variety of electro-mechanical hazards and radiation May be required to wear protective equipment as necessary May be exposed to hazards of flammable, and/or explosive gases May be exposed to outside elements (accidents, injuries, illness, death) May be exposed to varying and unpredictable situations May be occasionally subject to irregular hours May be exposed to stress due to multiple tasks & demands for time Able to walk, stand, sit, lift, push, pull, carry, stoop, kneel + climb without restriction May be exposed to extreme weather changes - hot, cold, and wet. May be exposed to dust, vapors, fumes

Requirements

Must possess ability to interact with variety of individuals as a problem-solver and have very good verbal and written communication skills.
Strong analytical and organizational skills essential.
Demonstrates excellent customer service skills when responding to incoming or outgoing calls in a most courteous manner providing clear and appropriate information as needed.
Exercises good judgment towards account resolution and documents all activity on account in a clear, accurate and consistent manner utilizing appropriate system.
Successfully completed previous year’s goals or performance improvement plan.

Responsibilities

Follow-up on all claims from billing through final resolution for commercial insurance and managed care claims.
Perform necessary correction to errors received from daily electronic billing reports, paper claim submissions and third party confirmation reports. Where applicable, make necessary corrections in the billing system.
Expedite payment of outstanding accounts through regularly scheduled follow up activity.
Review system generated reports to identify accounts requiring research based on guidelines established by department. Determine appropriate action to be taken for resolution of accounts, securing prompt and accurate payment. Documents result in appropriate system(s) and Log. Alert Supervisor and/or Manager of non-payment trends.
Research partial payments and determine if appropriate contractual allowance was calculated at time of billing based on reimbursement rules. Initiate corrective action for resolution of account, including collaboration with clinical department. Document results in appropriate system(s) or Log. Alert Supervisor and/or Manager of trends with miscalculation of contractual allowances
Research rejected and/or denied services. Determine corrective action to be taken. Complete corrective action, utilizing departmental procedures, policies, and document results in appropriate system(s) and Log. Alert Supervisor and/or Manager of non-payment trends
Complete productivity reports and forward to Supervisor per established time frame
Support customer service and performance improvement goals of the department; collaborate with other staff, within and outside the Department, to develop means of enhancing patient care and service
Maintain standards of confidentiality
Resolves credit balances in accordance to departmental policy and procedure.
Maintains, process and log in AR records all requests for MR
Is knowledgeable of and adheres to all hospital policies and procedures
Performs other duties as assigned.