Position Summary: Processes and enters charge information into database. Completes billing process and distributes billing information. Verifies insurance benefits and assists with referrals. May prepare checks for deposits. Monitors accounts receivable to maintain appropriate levels and reviews payments to maximize reimbursement. Interacts with patients, insurance carriers, the Billing Department and practice personnel concerning patient accounts. Performs all functions in a courteous and professional manner. Assures all appropriate licensure, certifications and/or accreditations are secured according to policy to include all credentialing issues related to the service.
Coordinates all Insurance Authorizations for the service.
Verifies and updates necessary information; enters patient demographics and insurance information into the computer.
Review tickets for accuracy and completeness, determine appropriate fees for services rendered, calculate totals, collect appropriate amount from patients, properly record information. Responsible for posting hospital charges or other satellite services. Utilizes correct ICD9, CPT and HCPCS coding methods to determine the proper code for the services rendered.
Responsible for cross-checking tickets and correcting all detected errors; notifies physician and patient of corrections. Reconciles daily charge tickets within established guidelines.
Processes payments received in person and by mail. Records, totals and prepares monies for deposit according to company procedure.
Makes adjustments to patients' account including editing charge entries and entering charge corrections, according to established procedures.
May reconcile over-the-counter payments with daily input and makes adjustments as needed.
Handles collection efforts for all outstanding accounts including patient calls and sending correspondence. Takes necessary steps to establish acceptable payment schedules or refer propriate accounts to collection agency.
May post over-the-counter payments to accounts (or NSF checks) for outstanding balances, including discounts, adjustments and write-offs.
Obtains approval/arrangement of Budget plan booklets as established by policy or practice. Follows up to determine if payment arrangements are being met, contacts patients to resolve problems, responds to correspondence or telephone calls from patients about accounts.
Follows up, either by telephone or in writing, with insurance companies and patients regarding the processing of outstanding claims and/or appeals.
Reviews all Explanations of Benefits (EOBs) and initiates collection procedures for those with zero payments.
Maintains NSF checks to ensure the applicable account is added back to accounts receivable, in accordance with NSF policies and procedures.
Generates various reports necessary to manage accounts receivable, including denial reports, insurance follow up reports, NSF reports and month end reports.
Communicates information to appropriate personnel. Educates staff on corrections, e.g. front-end entry errors in a positive, constructive manner.
Collects and reviews managed care contracts for correct billing and payment terms.
Identifies problem accounts and follows through to completion.
Reviews EOBs to ensure proper reimbursement of claims and reports any problems, issues or payer trends to supervisor.
Reviews credit balance reports for correct recipient of refund.
Resolves patient billing complaints and questions, initiates adjustments as necessary.
Participates in company sponsored collection forums and other educational activities.
Helps fiscal management and other administrative staff in implementing cost effective policies and procedures for all areas including billing, insurance, fee schedules, credit/collections, purchasing, and data processing.
Gathers and reports monthly and annual data for fiscal, statistical and planning purposes. Develops and implements revenue enhancement strategies for existing practices.
Responsible for assuring all appropriate licensure, certifications and/or accreditations are secured according to policy.
Follows the CHRISTUS Physician Group guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).
Maintains strict confidentiality.
Uses oral and written communication skills to effectively convey ideas in a clear, positive manner that is consistent with the CHRISTUS Mission.
Maintains established CHRISTUS Physician Group policies, procedures, objectives, quality assurance, safety, environmental and infection control.
Implements job responsibilities in a manner that is consistent with the CHRISTUS Mission and Code of Ethics and supportive of CHRISTUS Physician Group's cultural diversity objectives.
Supports and adheres to CPG Service Guarantee.
Performs other related work as required.
Qualifications: High school diploma or GED. Three years of accounts receivable experience including two years of experience in a health care organization; one year of experience in a managed care setting preferred. Working knowledge of ICD9, CPT and HCPCS coding. Knowledge of Medicare, Medicaid, Champus and Worker's Comp. Ability to operate 10 key calculator by touch. Knowledge of medical software systems. Ability to prioritize multiple tasks.
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.