Analyst-Revenue Recovery
2 days ago
Job Summary
Performs all collection and follow up activities with third party payers to resolve all outstanding balances and secure accurate and timely adjudication. This position is responsible for net and gross outstanding in accounts receivable, percentage of accounts aged greater than 90 days, cash collections, and denials resolution in support of the team efforts in the achievement of accounts receivable performance goals. The Specialist performs daily activities related to the successful closure of aged accounts receivable.
Responsibilities
- Performs online account status checks and contacting payers to follow-up on outstanding claim balances of assigned accounts in work queues.
- Clearly documents in EMR system the patient account notes, the payment status of the account, and/or actions taken to secure payment. If applicable, requests account for additional follow up activity within a prescribed number of days in accordance with payer specific filing requirements or processing time required for insurance to complete processing.
- Performs required actions to resolve the account balance promptly by submitting appeals, correcting account information, coordinating requests for medical records, requesting and/or performing posting of account adjustments, requesting an account rebill and any and all other actions necessary to secure account payment and/or bring the account to successful closure.
- Documents, tracks, and ensures a reasonable turnaround time of receipt of any outstanding documents required from external departments.
- Responds to claim denials from payers such as inability to identify the patient, coordination of benefits, non-covered services, past timely filing deadlines, and ensures all information is provided to the payer.
- Documents all actions taken on accounts in the EMR system account notes to ensure all prior actions are noted and understandable.
- Informs the supervisor of any problems or changes in payer requirements and exercises independent judgment to analyze and report repetitive denials to take appropriate corrective action.
- Achieves established productivity and quality standard as determined by the Baptist Productivity and Quality Expectations Documentation
- Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact patient account collections. Adheres to internal controls for applicable state/federal laws, and the program requirements of accreditation agencies and federal, state and private health plans.
- Seeks advice and guidance as necessary to ensure proper understanding.
- Effectively utilizes payer websites as needed in the execution of daily tasks.
- Conducts account claim status and follow up and resolves claim payment denials.
- Monitors assigned work queues at all sources and ensures expeditious resolution while working with other departmental representatives in resolution.
- Reports unresolved issues and concerns impeding the collection process and to ensure successful account resolution.
- Complies with patient confidentiality policies for the retention of patient health information, or when handling, distributing, or disposing of patient health information.
- Performs other duties as assigned by the Supervisor.
Experience
Minimum Required
- Experience in the healthcare setting or educational coursework
- One (1) year experience in physician's office or hospital setting.
Minimum Required
Preferred/Desired
Training
Minimum Required
- PC skills and keyboarding Working knowledge of 10 key, typing and computers. Proficiency in Microsoft Office
- Knowledge of insurance billing and collections and insurance guidelines.
Minimum Required
- Ability to type and key accurately, problem solving, written an d oral communication skills, financial counseling skills - knowledge of insurance billing (both hospital and professional settings) and collections - knowledge of insurance guidelines as it relates to CMS guidelines, TennCare and/or Medicaid based by state specified requirements. Ability to recognize and communicate to clinical staff or designee when insurance companies require additional review because of NCCI, CCI , LMRP, Mutually Exclusive and Medical Necessity edits. Effective Verbal, written and customer service skills as it relates to patients and insurance companies. Able to create communications to patients and insurance companies as needed to resolve issues to complete billing/claim processes.
- Knowledge of ICD-9, ICD-10, CPT and HCPCS codes and certification and/or degree in Healthcare Administration Business, Finance or related fields preferred.
- n/a
Minimum Required
Preferred/Desired
-
Analyst-Revenue Recovery
2 days ago
Jackson, MS, United States Baptist Memorial Healthcare Corporation Full timeOverview Summary Responsible for identifying accounts with payment review opportunities, appropriately communicating with payers regarding contract compliance responsibilities, and resolving reimbursement discrepancies. This position often participates in special projects. Performs other duties as assigned. Responsibilities Effectively manages work...
-
Analyst-Revenue Recovery
2 weeks ago
Jackson, MS, United States Baptist Memorial Healthcare Corporation Full timeOverview Summary Responsible for identifying accounts with payment review opportunities, appropriately communicating with payers regarding contract compliance responsibilities, and resolving reimbursement discrepancies. This position often participates in special projects. Performs other duties as assigned. Responsibilities Effectively manages work...
-
Analyst-Revenue Recovery
5 days ago
Jackson, MS, United States Baptist Memorial Healthcare Corporation Full timeOverview Summary Responsible for identifying accounts with payment review opportunities, appropriately communicating with payers regarding contract compliance responsibilities, and resolving reimbursement discrepancies. This position often participates in special projects. Performs other duties as assigned. Responsibilities Effectively manages work...
-
Analyst-Revenue Recovery
6 days ago
Jackson, MS, United States Baptist Memorial Healthcare Corporation Full timeOverview Summary Responsible for identifying accounts with payment review opportunities, appropriately communicating with payers regarding contract compliance responsibilities, and resolving reimbursement discrepancies. This position often participates in special projects. Performs other duties as assigned. Responsibilities Effectively manages work...
-
Business Analyst
2 days ago
Jackson, MS, United States HCL Global Systems Full timeDescription: Candidate must have experience with project management and be well versed in the technical design and implementation of eligibility systems for SNAP, TANF. Experience technical analyst with a background in system development supporting mid-to-large-scale human services enterprise systems; Knowledge of USDA-FNS guidelines and working in a state...
-
Business Analyst
6 hours ago
Jackson, MS, United States HCL Global Systems Full timeDescription: Candidate must have experience with project management and be well versed in the technical design and implementation of eligibility systems for SNAP, TANF. Experience technical analyst with a background in system development supporting mid-to-large-scale human services enterprise systems; Knowledge of USDA-FNS guidelines and working in a state...
-
Business Analyst
2 hours ago
Jackson, MS, United States HCL Global Systems Full timeDescription: Candidate must have experience with project management and be well versed in the technical design and implementation of eligibility systems for SNAP, TANF. Experience technical analyst with a background in system development supporting mid-to-large-scale human services enterprise systems; Knowledge of USDA-FNS guidelines and working in a state...
-
Epic Environment Management Analyst
2 weeks ago
Jackson, MS, United States CVS Health Full timeAt CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for...
-
Business Analyst
15 hours ago
Jackson, MS, United States blueStone Solutions Group Full time**Elevate Your Career as a Consultant: Unlock Diverse Opportunities with Bluestone** Are you ready to take your consulting career to the next level? Join Bluestone, where you'll experience unparalleled growth opportunities, work on diverse projects, and collaborate with multiple clients across various industries. As a Bluestone consultant, you'll be at the...
-
Business Analyst
10 hours ago
Jackson, MS, United States blueStone Solutions Group Full time**Elevate Your Career as a Consultant: Unlock Diverse Opportunities with Bluestone** Are you ready to take your consulting career to the next level? Join Bluestone, where you'll experience unparalleled growth opportunities, work on diverse projects, and collaborate with multiple clients across various industries. As a Bluestone consultant, you'll be at the...
