Reviews reports from insurance companies/government payers for possibility of re-submission. Resubmits, bills patient, or writes-off as appropriate. Files appeals on rejected services within filing deadline. (E)
Follows-up on unpaid third party accounts by telephone and/or tracer within time frames and guidelines set forth in hospital policies and procedures. Prepares rebilling as necessary. (E)
Reviews correspondence received from third party carriers, etc., and responds before insurance company deadlines. Makes request for medical records when necessary. (E)
Reviews payments on accounts for accuracy. Contacts insurance carriers if payment is less than quoted benefits to resolve balance responsibility. Calculates or recalculates contractual allowances and corrects as necessary. Corrects Managed Care discounts, employee discounts, etc., as necessary after recalculating discount. (E)
Documents all insurance activity in computer system. (E)
Demonstrates competence to perform assigned responsibilities in a manner that meets the population-specific and developmental needs of members served by the department. (E)
Appropriately adapts assigned assessment, treatment, and/or service methods to accommodate the unique physical, psychosocial, cultural, age specific and other developmental needs of each member served. (E)
Demonstrates adherence to the CORE values of Santa Rosa Health Care. (E)
Performs other duties as assigned. (M)
This job description is intended to be a tool to describe the primary purpose of the job and the key duties/responsibilities. The job description may not be inclusive of all duties and job assignments. Job duties and responsibilities may be added, deleted, and/or revised at the discretion of management. This is a description of the way this position currently performs the job functions and does not address the potential for accommodation, which would be addressed on a case-by-case basis
Employees must use company provided email for all electronic communications.
Education High school diploma required. Experience
One (1) year minimum experience with third party billing rules and regulations, preferably in a health care setting.
Other Skills/Competencies Must be able to understand both written and verbal instructions. Performs other duties as assigned. Equipment Must be able to operate a calculator. Must be able to operate both a calculator and a personal computer for inquiry and input purposes. Must be able to type a minimum of 35 wpm. Must have knowledge of mathematical computations required to calculate discounts, contractual allowances, etc. Must have good telephone skills. Computer Skills Computer literacy is desired
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.