Patient Financial Services Reimbursement Specialist II

Description

Summary:

Coordinates and monitors all aspects of Patient Financial Services daily functions, including billing compliance and accounts receivable functions.��Responsible for the assigned areas' claims submission, payment application, denial management, and account follow-up to ensure optimal reimbursement.

Responsibilities:

1. Coordinates/monitors all aspects of billing/accounts receivable management; ensures compliance, efficiency & reimbursement; includes accurate & timely preparation/submission of claims, payment & rejection application & follow-up for reimburse receivables.
2. Receives and processes payments & rejections for assigned work group accurately & timely. Performs trend analysis for management in order to determine registration & documentation deficiencies throughout the organization.
3. Responsible for daily completion & correction of information for claims edit lists & rejections; identifies training issues within the department. Provide immediate access to explanation of benefits (EOB's), reports & other information as requested.
4.  Processes claims on a daily basis & perform timely follow-up. Supports Team Leader; ensures appropriate completion of department workflow. Offers guidance & training to lower level staff & provides input to Level I staff member's performance if requested.
5.  Provide feedback to designated Hospital contacts regarding billing and reimbursement issues & changes in procedures, rules & regulations including immediate feedback to management regarding payment rejections as necessary.
6. Participate in meetings with supervisors and/or managers to review issues including staff training & education, A/R management & reimbursement issues.
7. In addition to the processing of refunds, credit balances and unapplied cash, support the Team Leader in monitoring the accuracy & completion of the entire cash application process. 8
8. Adheres to all policies and procedures related to compliance with all federal & state billing & collection regulations & third party contractual obligations. 
9.  Identifies and resolves problems associated with billing, procedures, system functionality, etc & reinforces training for staff as necessary & make recommendation to management for improvement &/or resolution.
10. Maintains departmental policies and procedures.
11. Adheres to all policies and procedures related to compliance with all federal & state billing & collection regulations & third party contractual obligations.
12. Fulfills all compliance responsibilities related to the position.
13. Performs other duties as assigned.

Other Information:

Required: Data entry and MS Excel. Customer service experience required.

Minimum Experience: one year Desired: Medical terminology, billing, cash applications and collection experience.

Working Conditions:

Manual: significant manual skills/motor coord & finger dexterity

Occupational: Little or no potential for occupational risk

Physical Effort: Sedentary/light effort. May exert up to 10 lbs. force

Physical Environment: Generally pleasant working conditions

Company: Nuvance Health

Org Unit: 1826

Department: Patient Accounting Med Practic

Exempt: No

Salary Range: $19- 25vHourly