Job Details

Position Summary:

Responsible for accurate and timely inpatient and outpatient billing, claims follow up, denial reviews and auditing accounts for accuracy. Works closely with Intake, UR and Medical Records. Employee must have solid understanding of insurance contracts. Strong analytical skills, the ability to work unsupervised, proficient in Microsoft Excel, a strong attention to detail and exceptional work ethic.

This position requires a comprehensive understanding of accounts receivable management in a healthcare setting. Strong customer service, organizational and communication skills are essential to this position. In addition, strict adherence to Patient Accounts policies as outlined in the Procedure Manual is required. This position requires an ability to prioritize multiple tasks simultaneously in an occasionally stressful environment. Also required are general computer skills, typing skills and a working knowledge OSHA and HIPAA guidelines.

Position Responsibilities:

Clinical / Technical Skills (40% of performance review)

• Verify authorizations match services rendered
• Knowledgeable insurance benefits, covered services and billing procedures of all Government and non-Government insurance programs.
• Maintains a current awareness of third-party reimbursement regulations and contractual arrangements with HMOs and PPOs.
• Reviews patient bills for accuracy and completeness, obtains any missing information prior to releasing claims.
• Follows up on unpaid claims within standard billing cycle timeframe
• Reviews insurance payments for accuracy and compliance with contract discount
• Identifies and bills secondary or tertiary insurances
• Research denied claims and follows up on appeal status
• Consistently meets SUNs standard of 30 accounts a day with positive outcomes
• Perform data entry utilizing Electronic Health Record for documentation of insurance information with minimal errors
• Ability to obtain single case agreements with non-contracted insurance companies.
• Understands and resolves billing appeals/denials
• Resolves credit balances
• Identify and recommend process improvements-based job functions.
• Understands how to balance patients accounts.
• Understands insurance contracts and can apply to balancing an account.

• Performs other duties as assigned

Safety (15% of performance review)

• Strives to create a safe, healing environment for patients and family members
• Follows all safety rules while on the job.
• Reports near misses, as well as errors and accidents promptly.
• Corrects minor safety hazards.
• Communicates with peers and management regarding any hazards identified in the workplace.
• Attends all required safety programs and understands responsibilities related to general, department, and job specific safety.
• Participates in quality projects, as assigned, and supports quality initiatives.
• Supports and maintains a culture of safety and quality.

Teamwork (15% of performance review)

• Works well with others in a spirit of teamwork and cooperation.
• Responds willingly to colleagues and serves as an active part of the hospital team.
• Builds collaborative relationships with patients, families, staff, and physicians.
• The ability to retrieve, communicate, and present data and information both verbally and in writing as required
• Demonstrates listening skills and the ability to express or exchange ideas by means of the spoken and written word.
• Demonstrates adequate skills in all forms of communication.
• Adheres to the Standards of Behavior

Integrity (15% of performance review)

• Strives to always do the right thing for the patient, coworkers, and the hospital
• Adheres to established standards, policies, procedures, protocols, and laws.
• Applies the Mission and Values of SUN Behavioral Health to personal practice and commits to service excellence.
• Supports and demonstrates fiscal responsibility through supply usage, ordering of supplies, and conservation of facility resources.
• Completes required trainings within defined time periods, as established by job description, policies, or hospital leadership
• Exemplifies professionalism through good attendance and positive attitude, at all times.
• Maintains confidentiality of patient and staff information, following HIPAA and other privacy laws.
• Ensures proper documentation in all position activities, following federal and state guidelines.

Compassion (15% of performance review)

• Demonstrates accountability for ensuring the highest quality patient care for patients.
• Willingness to be accepting of those in need, and to extend a helping hand
• Desire to go above and beyond for others
• Understanding and accepting of cultural diversity and differences

Education

• Required: High school diploma or GED. Basic medical terminology.
• Preferred: Bachelor's degree in a healthcare or business-related field
• May substitute experience for education
• Maintains education and development appropriate for position

Experience

• Required: One to two years previous experience in related field. Knowledge of insurance payor rules and regulations.
• Preferred: Experience with HIPPA regulated environment, processing ICD10 CPT/HCPC's, EOB's, third party payers, Medicare, managed care and private pay. Understanding of behavioral health treatment modalities. Working experience in HCS system a plus