Medical Billing
3 days ago
The Patient Advocate is responsible for effectively managing the billing cycle for assigned client site(s) by working the 4 C’s: Charges, Claims, Cash, and Collections to achieve Gold Standard Results. Accountable for reviewing charges for accuracy, submitting clean claims, posting and reconciling payments, and resolving insurance and patient accounts receivables to payment resolution. The Patient Advocate must be able to handle multiple, simultaneous tasks effectively and efficiently and is expected to demonstrate ENCORE in all communications.
Key Skills
- Excellent verbal and written communication
- Problem Solving
- Customer service focused
- Relationship building
- Self-motivated
- Strong organization skills
- Adaptability and willingness to remain flexible when changes occur
ENCORE
- Encourage others’ success
- New ideas; anticipate problems
- Create financial value for our clients
- Ownership towards a solution
- Reach Life Balance
- Embody a positive approach
Vitals for Success
- Understands insurance terminology, including deductibles, out-of-pocket coinsurance, copayments, and in-network and out-of-network.
- Perform daily review of charges queued to go out to third party payers for clean claim submission.
- Post incoming insurance and patient payments daily and ensure payments reconcile to client(s)
- Manage A/R by working denials and delinquent insurance balances
- Evaluate, prioritize, and perform A/R follow-up work through phone calls, appeals, claim corrections and re-files as needed to resolve A/R balances
- Document accurate collection activity for reporting and tracking
- Knowledge of insurance plans and patient payment options available
- Understands how to read the patient’s ledger and correct reassignment of coinsurance, co-payments, and deductibles to the patient.
- Answer incoming calls on or before the third ring
- Follows patient balance protocol and provides support with patient questions, and requests and assists patients with creating payment plans and/or taking credit card payments
- Gather, analyze, and communicate monthly accounting summaries and closing reports for management and client review and communicate to client in a timely manner
- Familiarity with RBS Revenue Cycle Structure - Clients and Physicians
- Stays current on training processes and developments within the company
- Reviews processes and provides suggestions for process improvements and efficiencies
- Learn radiation oncology-specific CPT codes, terminology, payer trends and billing requirements
- Perform additional duties as assigned by management
- Exhibit ENCORE values
Vital Metrics
- Interacts with physicians, medical office personnel, and patients to ensure the A/R cycle is completed in an accurate and timely manner
- Charges are filed within 3 days of charge receipt
- ERA payments should account for at least 95% of total insurance payments to reduce manual posting work
- DSO goal is less than 35 days
- Aging goal for A/R over 90 days is below 15% of total A/R for assigned client(s)
- Collections A/R follow-up accounts for 33% of workload
- Meet monthly goal of defined number of patient interactions
- Meets defined monthly number of client engagement and/or interactions
Physical Demands
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Ability to lift/carry up to 25 pounds. Ability to sit/stand for long periods of time. Good manual dexterity with the ability to perform repetitive hand/wrist motions. Ability to manage multiple tasks as assigned and handle stressful situations. Works in typical office environment. The noise level is usually moderate. May require travel at times to either client sites or RBS office locations. Requires mastery of complex language, comprehension, reasoning, and analytical skills typically found in mid to high-level work.
Requirements:To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education/Experience
- High School Diploma
- One or more years of healthcare billing experience, preferred.
- Excellent communication skills (strong spelling, proofreading, and grammar skills)
- Knowledge of Microsoft Office products (Word, Excel, Outlook)
Other Expectations/Skills
- A servant-minded approach to assisting patients, clients, colleagues, and management.
- Experience with computerized practice management/billing systems and software
- Knowledge of ICD10, CPT, and HCPCS Codes, preferred.
- Knowledge of medical business office procedures and medical terminology, preferred.
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