This position is responsible for conducting regular analysis of payments received from contracted payers, making quantitative comparisons to determine if the hospital received the appropriate reimbursement, monitoring contractual allowances, analyzing and pursuing appeal opportunities with contracted payers and reporting variance/appeals performance.
- 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.
- Reviews and analyzes accounts and EOBs to identify under-allowed claims.
- Batches, compiles, and submits appeals and monitors payments for proper reimbursement. Documents all variance and appeal activity in the hospital system.
- Creates reports to aid in workflow and appeal opportunities and track recovery payments.
- Establishes and maintains effective communication with employers, other healthcare providers, insurers, and patient/families to secure accurate and pertinent information to maximize reimbursement.
- Monitors and tracks contractual, billing, registration, and posting errors and provides continuous feedback to the department supervisor regarding any consistently under-allowed claims.
- 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.
- Verifies applicable contract rates by reviewing EOB messages, patient ID card, and verifying member information for managed care plans.
- Performs miscellaneous job related duties as requested.