Job Description

AND SCOPE

To seek reimbursement for hospital patient accounts by accurately billing third party payors and patients, and performing follow-up as necessary to secure payment for each patient account.

ESSENTIAL JOB FUNCTIONS

• Reviews bills daily as they are printed and edits bills as necessary in preparation for submission to third party payors
• Reviews daily rejections from third party payors and re-submits within 5 business days.
• Contacts third party payors to seek information and to solve problems that arise during the reimbursement process
• Meets with patients to solve problems with patient accounts
• Reviews a monthly aged trial balance in order to prevent accounts from aging past filing limits and takes corrective action
• Manage assigned accounts to an average of 50-60 days in AR, or as assigned.
• Keeps abreast of new laws, compliance and changes in third party billing process
• Reviews various reports for overpayments, late posted charges, incorrectly posted charges and payments, and takes corrective action, being mindful of applicable filing limits.
• Processes credit balances due to overpayments in accordance with hospital policy
• Works with appropriate hospital departments to coordinate the reimbursement process
• Accepts cash payments and prepares receipts
• Processes hospital mail
• Seeks out needed information by staying informed and involved by attending meetings, reading memos, policies, meeting minutes, newsletters, email and other appropriate information in a timely manner.
• Reliable attendance and punctuality, including observing appropriate break times and extending a a
• Performs duties in a safe manner, in compliance with all safety policies and procedures
• Complies with the Code of Conduct and all appropriate policies and procedures
• Other duties, as assigned, that are relevant to the position and department

Requirements

PREFERRED

• Associates Degree in Business or two years related experience

PHYSICAL EFFORT AND ENVIRONMENT

Moderate: Occasionally lifts up to 25 pounds independently. Occasionally pushes/pulls 100 pounds. Stands or walks often.

EXPOSURE RISK

Exposure Category III: Employee not reasonably expected to be at risk for exposure to blood borne pathogens.

QUALITY IMPROVEMENT

• Maintains current knowledge of the hospital-wide Quality Improvement Program.
• Collaborates with management to improve the effectiveness of the department through the Quality Improvement plans and processes.
• Participates in the departmental and hospital-wide Quality Improvement activities as directed by the manager.

COMPLIANCE

• Adheres to the federal, state, and local statutes and regulations.
• Adheres to the Compliance Program policies and procedures of Down East Community.
• Adheres to all Privacy and Security policies and procedures of Down East Community.
• Communicates any concern related to compliance issues to manager of department or Compliance Officer.
• Communicates any concern related to confidentiality issues to the Privacy Officer.

*DECH is an equal opportunity employer.