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Performs self-pay collections or third-party billing/collections which includes a complex review of billing and collection activities. Resolves problems and demonstrates complete understanding of payer and/or patient requirements to ensure timely and accurate payment. Makes independent decisions based on the needs of the patients and/or payer situations.
Job Responsibility
Performs self-pay collections or third-party billing/collections which includes a complex review of billing and collection activities
Resolves problems and demonstrates complete understanding of payer and/or patient requirements to ensure timely and accurate payment
Makes independent decisions based on the needs of the patients and/or payer situations
Assists management in maintaining or reducing account receivable (AR) days to meet industry standards and improve organizational cash flows
Ensures UB04 and HCFA 1500 claims and/or self-pay patient accounts are billed in a timely, complete, and accurate manner in accordance with appropriate guidelines
Provides information regarding patient accounts in response to inquiries, safeguarding confidential information in verbal replies and correspondence
Demonstrates understanding of the entire revenue cycle
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
Researches and analyzes any correspondence received related to assigned accounts
Adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication
Analyzes patient accounts, determines non-collectable accounts, and recommends bad debt or charity write-offs when applicable
Analyzes and processes contractual write offs
Adheres to TMCH organizational and department-specific safety and confidentiality policies and standards
Performs related duties as assigned
Performs third party billing and collections functions which includes a complex review of billing and collection activities
Resolves claim edits and demonstrates complete understanding of payer claim requirements to ensure timely and accurate payment
Ensures timely and proper reimbursements by researching and resolving all aged receivables
Performs self-pay collections which include complex review of billing and collections activities
Resolves and researches any potential coverage to ensure timely and accurate payment
Has a complete understanding of all options to resolve the balances
Processes payments, sets up payment arrangements, and offers financial assistance to patients who are experiencing financial difficulty
Must exhibit strong knowledge of fair debt collections
Meets with patients/families to acquire payment options or complete financial applications for all special programs available to resolve accounts
Evaluates accounts and determines payment dates based on patient’s ability to pay and hospital policies
Explains charges, services, and hospital privacy regarding payment of bills
Provides back up phone support for the Customer Service team
Provides technical assistance to set up MyChart access
Works assigned work queues in a timely manner
In a high call volume setting, performs self-pay collections which include complex review of billing and collections activities
Researches any potential coverage to ensure timely and accurate payment
Evaluates accounts and determines payment dates based on patient’s ability to pay and hospital policies
Processes payments, sets up payment arrangements, and offers financial assistance to patients who are experiencing financial difficulty
Explains charges, services, and hospital privacy regarding payment of bills
Provides technical assistance to set up MyChart access, and answers inquiries submitted through MyChart
Works assigned work queues in a timely manner
Demonstrates a thorough understanding of all aspects of payment posting and the explanation of benefits key data and employ standards of best practice to ensure all balancing procedures and documentation guidelines are met
Responsible for posting payments both electronically and manually
Receives, reviews, organizes, and accurately post payments to the appropriate patient account
Attaches necessary documentation
Adjusts charge balances in accordance with Payer Explanation of Benefits (EOB) and Provider Contracts prior to posting
Correctly calculates adjustments and posts these to the accounts as well
Researches unidentified cash, resolves misdirected payments and verifies that adjustments
Communicates with insurance companies, state agencies AHCCCS/Medicaid, and vendors to research outstanding payments and to retrieve EOBs
Requirements
High School diploma or General Education Degree (GED) required
One (1) year of related experience such as medical billing or third-party collection, or customer service in a hospital, payer, or physician setting
Technical experience in CMS/Medicaid regulations and/or commercial payer billing requirements
Minimum one (1) years’ experience in a windows environment, including Excel