A large healthcare organization seeks Special Accounts Coordinator.
Job Summary:
Under the direction of Revenue Cycle Leadership, this position is responsible for billing & collections of outstanding account balances for commercial, government, & managed-care payors, as assigned. The Special Accounts Coordinator is required to identify payor trends & issues, analyze the impact to the organization & take appropriate action. It is a requirement for the Special Accounts Coordinator to read, interpret & apply complex payor contract language to expected reimbursementcalculations & pursue all payments due to the organization. The Special Accounts Coordinator must perform account collection activities utilizing internet resources & professional telephone communication etiquette. The Special Accounts Coordinator is required to compose professional written correspondence with all internal & external entities. Must demonstrate organizational & time management skills to manage account collections. Serves as a resource to the Reimbursement Specialists in identifying payor issues & trends. Assists with training of staff. Works with clinical department on revenue cycle issues including charges, E&M coding, authorizations, late charges, & other issues impacting the revenue cycle.
Responsibilities:
- Resolve all claim edits, stop bills, & account edits including late charges, charge errors, consecutive accounts, duplicate accounts, & claim errors in order to submit timely & accurate claims to government agencies, commercial payors & other payors, as assigned, in accordance with federal, state, industry regulations & standards.
- Knowledge of HIPAA billing requirements to include claims (UB & 1500 current versions), & basic CPT coding, ICD 9/ICD10.
- Ability to read & apply complex contractual arrangements to identify expected reimbursement to include fee schedules, per diems, high dollar stop loss, DRGs, APCs, & carve outs.
- Must review all denials & take corrective action based upon national denial reason codes, remark codes & payor specific codes.
- Must determine appropriate appeals or adjustments based upon analysis of the denial codes, charges, revenue codes, CPT codes, HCPCS codes, & ICD-9 (10) diagnosis/procedure codes.
- Must understand payor-specific requirements & utilize pay-or websites, procedural billing manuals, & standard operating procedures.
- Identifies all over payments & refunds within the guidelines of federal & state regulations, payor requirements, & hospital standard procedures.
- Receives & processes requests from patient families, insurance carriers, government entities, & other sources.
- Must provide appropriate requested information to ensure quality customer service & appropriate adjudication of claims.
- Compliant with Federal, state, & hospital regulations to ensure privacy is maintained in compliance with HIPAA.
- Identifies underpayments & other payer issues & pursues payment through contact with payor either by telephone, email, or formal written communication. Runs reports to analyze impact of payor denials/underpayments on the revenue cycle.
- Prioritizes work appropriately to ensure all accounts are being submitted & followed up in a timely manner to include credit balances, high dollar accounts, & aging accounts.
- Meets department quality & productivity standards.
- Assists leadership with training of new staff & with training staff on new processes & payor issue resolution.
- Works with clinical departments to assist with resolution of issues affecting revenue cycle to include charge errors, late charges, claim errors & invoice processing.
QUALIFICATIONS:
- Bachelor's Degree (Minimum)
- 5-7 Years of Experience (Preferred)
Required experience:
Healthcare, payors, billing, collections, denials, follow-up, commercial, government, managed-care: 5 years
Job Summary:
Under the direction of Revenue Cycle Leadership, this position is responsible for billing & collections of outstanding account balances for commercial, government, & managed-care payors, as assigned. The Special Accounts Coordinator is required to identify payor trends & issues, analyze the impact to the organization & take appropriate action. It is a requirement for the Special Accounts Coordinator to read, interpret & apply complex payor contract language to expected reimbursementcalculations & pursue all payments due to the organization. The Special Accounts Coordinator must perform account collection activities utilizing internet resources & professional telephone communication etiquette. The Special Accounts Coordinator is required to compose professional written correspondence with all internal & external entities. Must demonstrate organizational & time management skills to manage account collections. Serves as a resource to the Reimbursement Specialists in identifying payor issues & trends. Assists with training of staff. Works with clinical department on revenue cycle issues including charges, E&M coding, authorizations, late charges, & other issues impacting the revenue cycle.
Responsibilities:
- Resolve all claim edits, stop bills, & account edits including late charges, charge errors, consecutive accounts, duplicate accounts, & claim errors in order to submit timely & accurate claims to government agencies, commercial payors & other payors, as assigned, in accordance with federal, state, industry regulations & standards.
- Knowledge of HIPAA billing requirements to include claims (UB & 1500 current versions), & basic CPT coding, ICD 9/ICD10.
- Ability to read & apply complex contractual arrangements to identify expected reimbursement to include fee schedules, per diems, high dollar stop loss, DRGs, APCs, & carve outs.
- Must review all denials & take corrective action based upon national denial reason codes, remark codes & payor specific codes.
- Must determine appropriate appeals or adjustments based upon analysis of the denial codes, charges, revenue codes, CPT codes, HCPCS codes, & ICD-9 (10) diagnosis/procedure codes.
- Must understand payor-specific requirements & utilize pay-or websites, procedural billing manuals, & standard operating procedures.
- Identifies all over payments & refunds within the guidelines of federal & state regulations, payor requirements, & hospital standard procedures.
- Receives & processes requests from patient families, insurance carriers, government entities, & other sources.
- Must provide appropriate requested information to ensure quality customer service & appropriate adjudication of claims.
- Compliant with Federal, state, & hospital regulations to ensure privacy is maintained in compliance with HIPAA.
- Identifies underpayments & other payer issues & pursues payment through contact with payor either by telephone, email, or formal written communication. Runs reports to analyze impact of payor denials/underpayments on the revenue cycle.
- Prioritizes work appropriately to ensure all accounts are being submitted & followed up in a timely manner to include credit balances, high dollar accounts, & aging accounts.
- Meets department quality & productivity standards.
- Assists leadership with training of new staff & with training staff on new processes & payor issue resolution.
- Works with clinical departments to assist with resolution of issues affecting revenue cycle to include charge errors, late charges, claim errors & invoice processing.
QUALIFICATIONS:
- Bachelor's Degree (Minimum)
- 5-7 Years of Experience (Preferred)
Required experience:
Healthcare, payors, billing, collections, denials, follow-up, commercial, government, managed-care: 5 years