Senior Patient Financial Services Rep

Revenue Cycle Management Support This purpose provides a wide range of revenue cycle management support to the dialysis billing and physician billing operations. Efficiently coordinates billing processes for physician group and GE system maintenance for the dialysis group. Track and quantifies reimbursement trends and issues for Director of Patient Accounts. Monitors billing errors/edits and continues to develop process that will improve and/or increase the clean claim ratio. Billing: Prepare claims for submission daily by entering, verifying and reconciling charges, assuring that the daily and monthly billing deadlines are met. Ensures that the claims are clean and compliant based on federal guidelines as well as individual payer specifications. Assure timely claim submissions. Identify and quantify billing issues, internal or external, that may impact cash flow and report to management for resolution. Ensure all fee schedule tables, physician tables, payer tables, procedure code tables, etc are up to date, and current. Responsible to make sure that all updates to the database cross to the host as expected, i.e. EMR to Middleware, Middleware to billing host, billing host to middleware, middleware to clearinghouse, clearinghouse to payer. Confirm all file transfers occur as expected and by design Billing Reconciliation and Maintenance: Under the direction of the Director of Patient Accounts performs all End of Month duties for Dialysis Billing and/or physician billing. Includes reconciling treatments/visits from all CDC facilities, as well as researching and correcting any errors that present themselves in order to create a clean claim for payment. Maintains and problem shoots any software application programs related to the billing cycle. Acts as a point person to Facility Managers, Director of Clinical Operations, Regional Directors and Medical Secretaries to ensure information received from the EMR is accurate to allow for maximum reimbursement. Provides weekly reports to the Facility Managers, Director of Clinical Operations, Regional Directors, Director of Patient Accounts and CFO regarding unposted treatments throughout the week. Ensures that unposted treatments get posted into the EMR prior to scheduling the HL7 file creation. Accounts Receivable Management: Monitors claims submissions to payers to attempt to develop best practice that helps to increase clean claim ratio. Performs review of billing denials to create edits that are compliant with NUBC guidelines and consistent with the CMS guidelines related to claim submission. To work with our EDI submission vendor to maintain and/or obtain products that increase efficiencies, decrease payment lag, and reduce manual submission of claims. AR Review: Posting payments and reconciliation of daily deposits or Performing follow up to ensure insurance company has received the billed claim and/ or is responding or making payment Monitoring payer trends to identify payment inconsistencies based on the contract or other factors Managing denials Reconciling claim overpayments and claim underpayments by requesting refunds, or contesting the validity of a refund request/takeback, or providing additional information to substantiate additional payments. Education, Experience, Training: Bachelors' degree in Business Administration with a major in Finance or Accounting required. Related experience of 7 or more years can be accepted in lieu of a degree. Experience in submission requirements for both UB and 1500 claim types is essential. Proven ability to meet deadlines and work efficiently and accurately within strict time constraints is imperative. Must be detail oriented Excellent Customer Service, interpersonal and communication skills required. Proficient with Microsoft Outlook, Word, Excel, PowerPoint and Visio preferred Familiar with Lean/Six Sigma is preferred