Description - Reviews payer EOB's but not limited to payment accuracy, patient liability, and appeal grievances
- File appeals on underpayments
- Forward appeal letters to scanning
- Generate reports from the Managed Care module to identify issues but not limited to underpayments, total charge adjustments, missing calculations, and contract accuracy
- Generate reports from the Managed Care module to assist management identifying payer problem accounts
- Create a monthly Medicaid HMO underpayment report for the CFO
- Process incoming mail correspondence from payers within 3 business days.
- Follow up with the payer via phone and/or the website as needed
- Enter detailed notes explaining account activity in the Patient Accounts system including expected payment calculation
- Identify payer trends for resolution
- Report payer trends to the Director and/or Assistant Director of Patient Financial Services
- Assist the Reimbursement Specialist when needed
- Respond to patient inquiries within 2 business days
- Respond to interdepartmental inquiries within 2 business days
- Respond to payer requests within 2 business days
- Respond to emails within 2 business days
- Maintain courtesy and respect at all times when working with internal and external customers
RequirementsEducation
Required:
High School
Licenses & Certifications
Preferred:
C-Heartsaver