Posting Note: *Must have at least 2 years of hospital account follow up and collections. The qualified candidate must be knowledgeable with UB-04 billing, understand revenue codes and cpt codes. Have experience with DRG and fee schedule reimbursement. Be able to read and understand EOB’s, file appeals, grievances, and state fair hearings as needed for claim resolution/payment. Experience with AHCCCS and/or Commercial insurance follow up and resolution is required
This position oversees the collection activity for an assigned segment of the Accounts Receivable and performs collection duties in accordance with established federal and state regulations.
- Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
- Excellence in clinical care, service and communication
- Collaborative within our institution and with others who share our mission and goals
- Leadership that set the standard for pediatric health care today and innovations of the future
- Accountability to our patients, community and each other for providing the best in the most cost-effective way.
Performs account follow-up on outstanding insurance balances and takes the necessary action for account resolution in accordance with established federal and state regulations.
- Contacts all assigned accounts in the work queue daily and provide sound collection follow-up on outstanding insurance balances.
Batches, compiles, submits appeals and monitor accounts for proper reimbursement.
- Responsible for achieving and maintaining accounts receivable days at the established goal.
Establishes and maintains effective communication with employers, other healthcare providers, insurers, and patients/families to secure accurate and pertinent information to maximize reimbursement.
- Communicate with internal and external customers by telephone and mail to verify charge accuracy and/or correct account errors.
- Monitors and tracks contractual, billing, registration, and posting errors and provides continuous feedback to the department supervisor.
- Verifies applicable contract by reviewing EOB messages, reviewing patient ID card, and verifying member information for managed care plans.
- Uses good interpersonal skills to promote positive, effective interaction with customers and to promote quality service to ensure flow of information to appropriate staff and professionals.
- Provides detailed documentation on the collection system to explain the action taken or promise made. Obtains current information on all accounts and records information as required.
- Performs miscellaneous job related duties as requested.