PFS Receivable Analyst

HHC•Indianapolis, IN

3d•Onsite

About The Position

The PFS Receivable Analyst provides timely and accurate billing to facilitate optimized reimbursement, research and performance improvement initiatives. This includes the verification of billing data for accuracy and completeness, following regulatory requirements, and in order to resolve edits or exceptions detected during system processing of the claim in the patient accounting system, claim editing system or the payer, reviewing the medical record, facility protocol, other applicable documentation, and the understanding of payer denials, appeals process, and credit balances.

Requirements

Associate degree in business-related field preferred
Five years of accounts receivable experience in a hospital billing environment may be accepted in lieu of formal education
Knowledge of reimbursement procedures, provider coverage, complex state and federal regulations and policies, and Eskenazi Health procedures and policies
Ability to utilize support systems such as Epic, Onbase, nThrive, and/or other software applications
Excellent verbal and written communication and organizational skills
Extensive knowledge of and ability to research and identity payer billing and reimbursement guidelines
Ability to behave professionally and take team-oriented, solution-driven approaches to problem solving for all types of issues; high level of ethical behavior
Ability to complete tasks within given timeframes, remaining productive and goal-oriented
Ability to troubleshoot errors and resolve within a reasonable amount of time
Must be detail-oriented with the ability to multitask
Knowledge of PC applications such as MS Word and MS Excel; ability to learn software quickly and interpret instruction manuals
Knowledge of Epic Patient Accounting system
Ability to use computer 10-key entry and operate a calculator

Responsibilities

Proactively contributes to Eskenazi Health's mission: Advocate, Care, Teach and Serve with special emphasis on the vulnerable population of Marion County; models Eskenazi Health's values of Professionalism, Respect, Innovation, Development and Excellence
Responsible for the management and effective resolution of assigned high balance patient accounts to ensure appropriate cash flow is maintained, and patient satisfaction with administrative functions at Eskenazi Health are consistently positive; ensures timeframes are maintained according to Eskenazi Health policies and procedures, federal and state statutes, and payer's claim filing timelines
Responsible for the resolution of credit balances that have an outstanding high balance for hospital accounts
Troubleshoots current problems, anticipates potential problems and communicates regularly with Revenue Cycle Management team to clarify receivable issues and to resolve immediate problems
Collaborates with internal departments regarding registration, prior authorizations and/or insurance issues
Serves as a resource to other departments to resolve problems and expedite billing and collection processes
Analyzes standard system reports to ensure timely and accurate data processing
Answers e-mails and voicemails on a timely basis
Responsible for identifying and trending payer rejections and denials; implements system process improvements to prevent future rejections and denials
Coordinates with management and system support to identify opportunities to improve system automated process based on payer guidelines and regulations
Keeps up to date on account billing and collection rules and regulations, contract terms and conditions with regards to timely filing and service pre-certifications and authorizations
Works efficiently under pressure, acts independently and accepts responsibility for decisions
Provides coaching and mentoring to billing and follow up team members
Participates in monthly staff meetings to educate new payer habits and etc. as needed
Acts as liaison between department and division
Meets with insurance company representative to ensure positive and productive relationships
Completes payer appeals based on under payment, timely filing, medical necessity and prior authorizations
Works with management when contract variances are identified