Financial Counselor

3 weeks ago

Saratoga Springs, United States Saratoga Hospital Full time
Summary of Position: Responsible to bill primary, secondary and tertiary claims, to all list third party insurance carriers, utilizing multiple systems to ensure a clean claim is received and reimbursed at contracted rates. Follow up on Third Party receivables. Provide telephone customer service to assist patients with their insurance questions. Acts as a point of reference to PFSRs and department.

Primary Job Responsibilities:

Leadership: Identify areas of improvement and participate on various committees assigned for the revenue cycle process. Answer and respond to telephone inquiries by patients and/or insurance carriers to resolve insurance and/or customer's problems efficiently. Provide coverage within the department as assigned (floater).

Education: Provides continuing education for existing staff and assists with on boarding new employees. Understanding of systems, contracts, regulations, reports to assist and serve as the point person for Q/A as directed by department managers. Understand all components of a claim form and billing standards.

Knowledge: Extensive knowledge of payer classification categories as they relate to rules and regulations, contracts, claim form components, claim issues, carrier systems, Passport, Craneware, Iatric, Meditech as well as current and future processes of PFS.

Problem Solving: Identify trend using root cause analysis and contribute to resolution of denied claims as assigned. Problem Solve issues with third party payer as assigned.

Billing: Retrieve and Transmit electronic (837) claim files to all assigned payers as assigned. Submission of a paper Claim form to all assigned insurance carriers. Submit with all appropriate documents/attachments as assigned. Resolve all claim issues to ensure a clean claim has been received and accepted by assigned payer.

Denials:Handle and resolve all denied claims including those, identified through the CRANEWARE denials management software system. Monitor denied claims for trends in assigned payer classifications and report to management.

Reimbursement: Review and analysis payment discrepancies as assigned.

Follow Up: Provides follow-up by telephone/written communication on all accounts. Ability to use various assigned systems to submit and/or resolve claim issues. i.e., Omnipro, Emdeon, Navinet, Relay Health-E-Premise, Post N Track, ASK (Blue Shield), Ability/Vision share, E-PACES.. Research and resolve all credit balances in accordance with PFS policy as assigned. Complete assigned reports from Meditech to follow up on aging receivables as assigned. Monitor aged A/R for patterns and trends.

Minimum Qualifications: High school diploma or GED with at least 2 years in healthcare revenue cycle. Will consider a Bachelors in business, accounting or finance with no experience.

Salary Range: $17.25 - $28.27
Pay Grade: 18
Compensation may vary based upon, but not limited to: overall experience and qualifications, shift, and location.

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