SUMMARY: Develops and implements an action plan for processing and resolution of all insurance accounts. Is knowledgeable of third party payer requirements in order to expedite payment of accounts. Responsible for processing and following up with insurance payers on healthcare claims in a timely and efficient manner, to maintain cash flow in support of the mission and goals of the ambulance billing office. Position requires high level of customer service skills to establish and enhance positive relationships with our insurance contacts, third party payers, co-workers, departments and others.
ESSENTIAL DUTIES AND RESPONSIBILITIES: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. • Follows up with insurance payors, as assigned, on unpaid claims; makes appeals, requests medical reviews as needed, and reviews reimbursement daily. Uses both websites and calls as available. • Reviews and takes appropriate action on all correspondence received for assigned state or payor. Turnaround of 24 hours required, up to 72 hours as an exception. • Works payor rejections daily as provided on MREP (Medicare Remit Easy Print) including Medicare or any other payors populating in this file. • Works assigned workflows for any category of unpaid claims, including rejections posted. • Watches for trends in rejections codes/comments and reports to Supervisor. • Looks for accurate collection of payment (contractual and non contractual according to fee schedules). Reports as necessary. • Works with Coders to review trip runs to ensure medical diagnosis support reason for transport daily. Reports any diagnoses updates. • Provides billing support to management and operational staff by staying abreast of assigned state or payor insurance regulation updates and by keeping them informed. • Assesses discounts and requests payments for private (commercial) payors. • Assists with the submission of billing data via hard copy and electronically. Works with EDI specialist as needed. • Obtains and submits copies of medical documentation to support billing to third-party payors as required. • Identifies transport service provided, but not adequately documented in the medical record. Advises supervisor of deficiencies to support charge capture of all billing services.
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• Resolves a minimum of 40 accounts a day; an average of 320 weekly. • Collects revenue to achieve and exceed operational/Receivables goal. • Ensures HIPAA compliance with regard to billing practices. • Generates monthly reports as requested. • Continuously cross-trains in other function areas. • Takes calls from payors or patients generated by notification letters. Assist with any Billing Office calls as needed. • Other duties as assigned.
KNOWLEDGE, SKILLS & ABILITIES • Thorough knowledge of ambulance transport documentation. • Extensive knowledge of ICD-9 and Condition Codes. • Ability to collect for healthcare claims from MCR/MCD, commercial insurance, contracted facilities, and individuals. • Understands Medicare and Medicaid regulations and guidelines. • Familiarity with Medicare, Medicaid, Coding, Private Pay, and insurance preferred. • Familiarity with medical terminology. • Ability to interpret EOB (Explanation of Benefits) • Familiarity with Microsoft Office Suite • Working knowledge of RightCAD database
To perform the job successfully, an individual should demonstrate the following competencies:
• Analytical - collects and researches data; uses intuition and experience to complement data. • Design - demonstrates attention to detail. • Problem solving - identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; develops alternative solutions; works well in group problem solving situations; uses reason even when dealing with emotional topics. • Project management - communicates changes and progress; completes projects on time and budget. • Technical skills - assesses own strengths and weaknesses; pursues training and development opportunities; strives to continuously build knowledge and skills; shares expertise with others. • Customer service - manages difficult or emotional customer situations; responds promptly to customer needs; solicits customer feedback to improve service; responds to requests for service and assistance; meets commitments. • Interpersonal skills - focuses on solving conflict, not blaming; maintains confidentiality; listens to others without interrupting; keeps emotions under control; remains open to others' ideas and tries new things.
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• Oral communication - speaks clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions; participates in meetings. • Written communication - writes clearly and informatively; presents numerical data effectively; able to read and interpret written information. • Teamwork - balances team and individual responsibilities; exhibits objectivity and openness to others' views; gives and welcomes feedback; contributes to building a positive team spirit; puts success of team above own interests; able to build morale and group commitments to goals and objectives; supports everyone's efforts to succeed. • Quality management - looks for ways to improve and promote quality; demonstrates accuracy and thoroughness. • Diversity - shows respect and sensitivity for cultural differences; promotes a harassment-free environment. • Ethics - treats people with respect; keeps commitments; inspires the trust of others; works with integrity and ethically; upholds organizational values. • Organizational support - follows policies and procedures; completes administrative tasks correctly and on time; supports organization's goals and values. • Judgment - exhibits sound and accurate judgment; supports and explains reasoning for decisions; includes appropriate people in decision-making process. • Motivation - sets and achieves challenging goals; demonstrates persistence and overcomes obstacles; measures self against standard of excellence; takes calculated risks to accomplish goals. • Planning/organizing - prioritizes and plans work activities; uses time efficiently; plans for additional resources; sets goals and objectives; organizes or schedules other people and their tasks; develops realistic action plans. • Professionalism - approaches others in a tactful manner; reacts well under pressure; treats others with respect and consideration regardless of their status or position; accepts responsibility for own actions; follows through on commitments. • Quality - demonstrates accuracy and thoroughness; looks for ways to improve and promote quality; applies feedback to improve performance; monitors own work to ensure quality. • Quantity - meets productivity standards; completes work in timely manner; strives to increase productivity; works quickly and efficiently. • Safety and security - observes safety and security procedures; uses equipment and materials properly. • Adaptability - adapts to changes in the work environment; manages competing demands; changes approach or method to best fit the situation; able to deal with frequent change, delays, or unexpected events. • Attendance/punctuality - is consistently at work and on time; ensures work responsibilities are covered when absent; arrives at meetings and appointments on time. • Dependability - follows instructions, responds to management direction; takes responsibility for own actions; keeps commitments; completes tasks on time or notifies appropriate person with an alternate plan. • Initiative - volunteers readily; undertakes self-development activities; seeks increased responsibilities; looks for and takes advantage of opportunities; asks for and offers help when needed. • Innovation - generates suggestions for improving work. EDUCATION AND RELATED WORK EXPERIENCE • High school diploma or general education degree (GED)
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• Minimum of 1-year medical billing experience with a high volume practice or clinic, ambulance experience preferred. • Combination of education and experience considered.
LICENSES, REGISTRATIONS or CERTIFICATIONS
• Ambulance/Medical billing certification or diploma preferred.
Global Medical Response and its family of companies including American Medical Response is an Equal Opportunity Employer including Veterans and Disabled