Patient Financial Service Representative III - TMCOne
Ensures the efficient handling of all insurance billing, follow up and collection activities. Communicates with insurance companies, state agencies, AHCCCS and/or Medicare to resolve denials and to maximize reimbursement. Possesses strong knowledge of payer contracts and demonstrates complete understanding of payer billing requirements to ensure timely and accurate payment. Completes reconciliation and billing of accounts making independent decisions based on payer, coding and billing guidelines.
Maintains and fosters effective public relations with patients and public while negotiating payment plans with patients as authorized.
Adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication.
Assists management in maintaining or reducing account receivable (AR) days to meet industry standards and improve organizational cash flows.
Ensures patient accounts are billed in a timely, complete, and accurate manner in accordance with payer contracts or guidelines.
Provides information regarding patient accounts in response to inquiries, safeguarding confidential information in verbal replies and correspondence.
Prepares and enters contractual write-offs and grievance letters to insurance carriers as required.
Serves as information resource to patients and hospital staff regarding credit and collection policies.
Provides routine daily internal and external interface with unit/department management and staff, other service areas, information systems, physicians, physicians’ office staff, patients, software/hardware vendors, and third party payers in order to resolve patient concerns, disputes, and billing audits in order to receive payment.
Assists with problem solving, inquiries, and customer interaction to ensure positive results.
Ensures notification to ancillary departments and patients of changes or cancellations within schedules guidelines.
Analyzes patient accounts, determines non-collectable accounts and recommends bad debt or charity write-offs when applicable; analyzes and processes contractual write offs.
Arranges payment methods or extensions of credit with patients or representatives; evaluates accounts and determines payment dates based on patient’s ability to pay and hospital policies; explains charges, services, and hospital policy regarding payment of bills.
Trains and assists in the implementation of new software programs/systems and related technologies.
Adheres to TMCH organizational and department-specific safety and confidentiality policies and standards.
Performs related duties as assigned.
EDUCATION: High School diploma or General Education Degree (GED); or an equivalent combination of relevant education and experience.
EXPERIENCE: Three (3) years of related experience such as medical billing, collections or customer service, preferably in an acute care setting.
LICENSURE OR CERTIFICATION: None required.
KNOWLEDGE, SKILLS AND ABILITIES:
Knowledge of medical insurance practices and policies and regulations.
Knowledge of government and non-government uniform billing guidelines.
Knowledge of medical terminology and coding Related to hospital billing and/or professional billing such as revenue, CPT diagnosis codes and modifiers.
Skill in evaluating bills/claims for payers or patients in order to collect payment in a timely manner.
Possesses and maintains knowledge of current regulatory and third party payer requirements to support billing reimbursement.
Skill in providing assistance or training to other staff members in a team environment.
Skill in the use of computer applications and systems including:Excel, Word, Internet, email, and miscellaneous programs and networked computer systems.
Ability to read and comprehend instructions, short correspondence, and memos.
Ability to write correspondence; ability to effectively present information in one-on-one and small groups situations to customers, clients, and other employees of the organization.
Ability to read and interpret documents such as safety rules, procedure manuals, and governmental regulations.
Ability to effectively present information and respond to inquiries or complaints from payors, patients and/or their representatives, and the general public.
Ability to calculate figures and compute rate, ratio, and percent and to draw and interpret bar graphs; ability to apply basic algebraic concepts.
Ability to apply common senses understanding to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.