• Job Description

  Req#: 211574
  JOB PURPOSE:
  
  Primarily responsible for effective collection on patient accounts, accounts receivable follow-up, and reimbursement analysis for all non-Government accounts.
  
  ESSENTIAL FUNCTIONS INCLUDE BUT NOT LIMITED TO:
  
  • Manage assigned accounts ensuring outstanding/pending claims are paid at maximum reimbursement in a timely manner.
  • Request claims to be reprocessed where necessary or prepare and submit corrected claims to the insurance companies for payment.
  • Follow-up on all outstanding insurance claims at 30-days from the date of service with an emphasis on maximizing patient satisfaction and client profitability.
  • Review credit balance accounts for payer/patient refund requests and/or misapplied payments/adjustments.
  • Follow up on all returned claims, correspondence, denials, account reconciliations and rebills within two working days of receipt to achieve maximum reimbursement in a timely manner.
  • Communicate denials trends with Revenue Cycle Manager.
  • Knowledge of insurance guidelines, including HMO/PPO, Medicare, and Medicaid.
  • Obtain accurate and additional information from facilities as needed.
  • Comply with state and federal regulations, laws and company policies and procedures.
  • Help create, implement, and improve processes for the revenue cycle team.
  • Maintain strictest confidentiality.
  • Support management on special projects
  • Other duties as assigned.
  
  
  BEHAVIORAL STANDARDS:
  
  • The individual must support the mission, vision, and goals of Avem Health Partners and serve as a role model within the company.
  • Exhibit positive customer service behavior in everyday work interactions.
  • Demonstrate a courteous and respectful attitude to internal workforce and external customers.
  • Communicate accurately and appropriately.
  • Handle difficult situations in a discreet and professional manner.
  • Hold self-accountable for professional practice.
  • Demonstrate knowledge of unit goals and is active in committees and projects to achieve these goals.
  • Keep current with literature regarding changing practices, interventions, and best practices in patient care.
  • Assume responsibility for seeking out educational and professional opportunities for personal learning needs and growth as well as meeting mandatory education requirements.
  • Act as a preceptor as requested.
  • Demonstrate excellent work attendance and attend and actively participate in a variety of meetings and training sessions as required.
  • Adhere to the Avem Health Partners Code of Conduct and Standards of Behavior. Complies with established policies and procedures and all health and safety requirements.
  
  
  EDUCATION:
  
  • High school diploma or equivalent
  • At least two years of medical accounts receivable experience
  
  
  CERTIFICATION/LICENSURE:
  
  • Medical billing certification, if available.
  
  
  PHYSICAL REQUIREMENTS:
  
  • To perform this job successfully, an individual must be able to perform each essential job duties satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant to be considered.
  • This job requires visual abilities, auditory abilities, must be intact to perform duties.

• About the company

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