JOB SUMMARY:

Coordinates the billing and followup process between the organization, payers and patients independently. Analyzes and reports on insurance denial causes and trends. Acts as a resource and mentor for peers.


KEY RESPONSIBILITIES:

• Processes claims, payments, adjustments, refunds, denials, and unpaid patient and insurance balances.
• Accesses and corrects, if needed, demographic, insurance and financial information.
• Serves as a liaison with insurance companies, third party payors, and administrative personnel.
• Analyzes incoming financial data to identify, reconcile, and resolve patterns resulting in erroneous or no reimbursement.
• Performs account audits in their entirety as well as other complex projects.
• Prepares and maintains complex reports and records requiring the identification of sources, compilation, analysis and evaluation of data.
• The responsibilities listed are a general overview of the position and additional duties may be assigned.

TECHNICAL CAPABILITIES:

CODING KNOWLEDGE (INTERMEDIATE): - Ability to assign and interpret ICD-10-CM/PCS coding classification systems and MS-DRG and APR-DRG prospective payment and severity systems.

DATA ENTRY (INTERMEDIATE): - The ability to transcribe information from the original source into an electronic system according to written and verbal instructions efficiently and accurately.

REVENUE CYCLE (INTERMEDIATE): - Knowledge of the financial process to track patient care from registration and scheduling to the final payment of a balance.

PEER LEADERSHIP (NOVICE): - The ability to show leadership and influence people of equal rank in an effort to accomplish team goals.

CORE ACCOUNTABILITIES:

• Organizational Impact: Independently performs non-routine tasks that significantly impact team and other related teams.
• Problem Solving/ Complexity of work: Gathers and analyzes data to solve problems that arise with little or no precedent.
• Breadth of Knowledge: Applies advanced job knowledge and has developed a breadth of skills in other areas.
• Team Interaction: Serves as a lead for the team by providing expertise and guidance to team members.

CORE CAPABILITIES:

SUPPORTING COLLEAGUES (S4):

• - Develops Self and Others: Invests time, energy and enthusiasm in developing self/others to help improve performance and gain knowledge in new areas.
• - Builds and Maintains Relationships: Maintains regular contact with key colleagues and stakeholders using formal and informal opportunities to expand and strengthen relationships.
• - Communicates Effectively: Recognizes group interactions and modifies one's own communication style to suit different situations and audiences.

DELIVERING EXCELLENT SERVICES (S4):

• - Serves Others with Compassion: Seeks to understand current and future needs of relevant stakeholders and customizes services to better address them.
• - Solves Complex Problems Approaches problems from different angles; Identifies new possibilities to interpret opportunities and develop concrete solutions.
• - Offers Meaningful Advice and Support: Provides ongoing support and coaching in a constructive manner to increase employees' effectiveness.

ENSURING HIGH QUALITY (S4):

• - Performs Excellent Work: Engages regularly in formal and informal dialogue about quality; directly addresses quality issues promptly.
• - Ensures Continuous Improvement: Applies various learning experiences by looking beyond symptoms to uncover underlying causes of problems and identifies ways to resolve them.
• - Fulfills Safety and Regulatory Requirements: Understands all aspects of providing a safe environment and performs routine safety checks to prevent safety hazards from occurring.

MANAGING RESOURCES EFFECTIVELY (S4):

• - Demonstrates Accountability: Demonstrates a sense of ownership, focusing on and driving critical issues to closure.
• - Stewards Organizational Resources: Applies understanding of the departmental work to effectively manage resources for a department/area.
• - Makes Data Driven Decisions: Demonstrates strong understanding of the information or data to identify and elevate opportunities.

FOSTERING INNOVATION (S4):

• - Generates New Ideas: Proactively identifies new ideas/opportunities from multiple sources or methods to improve processes beyond conventional approaches.
• - Applies Technology: Demonstrates an enthusiasm for learning new technologies, tools, and procedures to address short-term challenges
• - Adapts to Change: Views difficult situations and/or problems as opportunities for improvement; actively embraces change instead of emphasizing negative elements.