INS FOLLOW UP REP- 1703

Essential Values-Based, Leadership and Management Competencies: Demonstrates competencies in line with the five core values that are the foundation of all activities performed by employees in order to achieve the Mission of Artesia General Hospital Servant Leadership: Demonstrates competence in serving others and prioritizing their needs. Excellence: Demonstrates competence in striving for the highest quality in all aspects of work. Respect: Demonstrates competence in respecting others and valuing their contributions. Virtuousness: Demonstrates competence in maintaining high ethical standards and integrity. Innovation: Demonstrates competence in embracing new ideas and technologies to improve healthcare. Community: Demonstrates competence in fostering a sense of community and collaboration. Education: Demonstrates competence in promoting continuous learning and development. ESSENTIAL FUNCTIONS: Answer phone calls Provides outstanding customer service to patients inquiring about their accounts. Confirms patient insurance eligibility and/or benefits. Audits charts for accuracy of billing/payment/income. Correct address information as required for guarantor, patient, insurance companies, employers etc.  Communicate those changes as appropriate. Discuss and educate guarantors and patients on various services offered by AGH and Clinics as well as methods of payment for those services including but not limited to Medicare, Medicaid, Insurance, Financial Assistance and other state and county assistance programs. Assist with the implementation of potential new systems and process changes. Assist with training new employees. Ensure accounts are followed up timely (within established payer guidelines). Follow up to ensure that accounts are paid within the established timeframes Ensure that the account is paid properly per the payer contracts. Will ensure that no more than 15% of A/R is to be over 90 days old. Will maintain account Quality rate that is no less than 96%. Timely filing adjustments are to be 0%. Will participate in the appeals and denials process to ensure claims are properly resubmitted and reprocessed for payment. Will work accounts identified through the contract management system that require addition steps to ensure proper payment. Will work outliers, catastrophic claims to ensure additional payment is received. Report any noted trends in the follow up system or denied claims reports. Will have strong attention to detail, will have effective communication skills. Utilize Audit Reports from billing system to ascertain proper receipt of claims to the appropriate payers. Is able to maintain established productivity standards. Will utilize electronic, web based or telephone communication tools to resolve outstanding insurance balances. Will provide feedback to management/supervisor regarding identified trends in billing or non-payment of outstanding insurance balances. Will resubmit claims to insurance payers as appropriate.  Will ensure resubmission of claim(s) is accurate by not resubmitting claims with the same problems repeatedly. Will be able to differentiate information on the Explanation of Benefits to determine next steps in resolution of outstanding balances. Will contact patient when need be to assist is resolving outstanding balances if required. ADDITIONAL RESPONSIBILITIES : Prompt response to e-mail and telephone calls. Exceptional interpersonal skills. Excellent communication. Excellent organizational skills. Manual Payment Posting: Input data from insurance remittance advices and patient payment batches into Patient Accounting System. Assist Business Office Lead/Supervisor/Manager/Director as required or assigned. Performs other necessary duties as required to meet the goal of providing exceptional customer service to the community and health system. Demonstrate awareness of age specific, cultural and spiritual practices of patients, staff and visitors. Complete Annual training/recertification as required. Understands the functional status and physical needs of patients, staff and visitors. Will treat all customers, coworkers, medical staff and the communities we serve with integrity and service excellence at all times as measured by documented communications to the Department Director. Will abide by the policies of Artesia General Hospital related to compliance. Will attend departmental/team meetings as required. Will complete annual education and training requirements. KNOWLEDGE/SKILL/ABILITIES: High school diploma or equivalent required. 1 - 3 years of experience in the healthcare setting (Hospital and/or medical office) working with insurance claims processing involving CPT, HCPCS, ICD-9CM, ICD-10CM and CMS regulations. Familiarity with CMS1500 and UB04 claim form completion. Strong analytical, oral, written communication skills. Familiarity with health insurance and other third party billing practices and guidelines. Proficient in Microsoft Word, Excel, Access, Outlook, and the like. Bilingual in Spanish and English a plus. Must be able to assess situations, identify issues/problems and prioritize duties. Reasoning Ability: Uses personal experience, knowledge and other outside resources to make logical decisions to solve problems. Utilizes Time Management and Organization skills. Strong attention to detail, is accurate and completes principle accountabilities timely. Professionalism. Understand medical terminology AGE-RELATED COMPETENCIES: Demonstrates the basic knowledge and skills necessary to identify age-specific patient needs appropriate for this position. Information Management: Treats all information and data within the scope of the position with appropriate attention to confidentiality, privacy, HIPAA and security policies/regulations. Risk Management/Quality Management/Safety: Cooperates fully in all Risk Management, Quality Management, and Safety Activities and Investigations. MINIMUM POSITION QUALIFICATIONS: Education – High school diploma or equivalent. Work Experience – Minimum 2 years of experience in the healthcare setting (Hospital and/or medical office) working with insurance claims processing involving CPT, HCPCS, ICD-9CM, ICD-10CM and CMS regulations. Familiarity with CMS1500 and UB04 claim form completion. Strong analytical, oral, written communication skills. Familiarity with health insurance and other third party billing practices and guidelines. Proficient in Microsoft Word, Excel, Outlook, and the like. License/Certification – none. ENVIRONMENTAL CONDITIONS: Work environment consists of daily patient contact in a fast paced office setting.