Job Description

Job Category:

Revenue Cycle

Work Shift/Schedule:

8 Hr Morning - Afternoon

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary

Bills third party claims to governmental payers. Performs insurance collection duties on delinquent insurance balances. Reviews accounts for previous collection activity and appropriately proceeds with collection activities. Manages communications with payers and employers as appropriate. Maintains clear and concise documentation of collection activities.

Minimum Job Qualifications

• Licensure or other certifications:
• Educational Requirements: High School Diploma or GED.
• Minimum Experience: One (1) year minimum collection or business office experience.
• Other:

Preferred Job Qualifications

• Preferred Licensure or other certifications:
• Preferred Educational Requirements:
• Preferred Experience: Previous hospital and or insurance collection experience.
• Other:

Job Specific and Unique Knowledge, Skills and Abilities

• Extensive knowledge of governmental billing regulations and collection procedures
• Proficiency with governmental payer systems to include DDE and MMIS
• Thorough knowledge of Third Party Billing guidelines and UB04 data
• Teamwork skills necessary
• Ability to multi-task by working in various systems simultaneously
• Excellent problem solving and analytical skills
• Excellent verbal and written communication skills

Essential Tasks and Responsibilities

• Ability to thoroughly review and understand all documentation in the NGMC Patient Accounting core system.
• Proficiency is required in the claims processing software. Thoroughly reviewing claims and making necessary corrections prior to submission to the payer.
• Maintains the number and dollar amount of claims held in the billing scrubber to the expected minimum levels, alerting supervisor promptly if unable to resolve an error within 24 hours.
• Identify, retrieve, print and mail hard copy claims for non-electronic payers, i.e. workers compensation and auto insurance.
• Resolve claim rejections daily and work with supervisor to "root cause" and report to the appropriate departments on a regular basis.
• Contacts insurance companies via telephone and websites to expedite claim processing and payment.
• Completes Medical Records requests as needed via the HealthPort "e-request" system.
• Documents the patient account thoroughly and accurately in order to leave sufficient information for any other party reviewing the account for future collection efforts, which may include presentation in court.
• Assists other Revenue Cycle departments in dealing with insurance collection matters.
• Documents collection efforts in the "Receivables Workstation" system to accurately identify insurance denial/delay root causes.
• Contacts patients and/or responsible parties to inform them of documents or information needed for insurance to process claim for payment.
• Actively participates in the " Governmental Payer" team, including visual management and LEAN problem solving activities.
• Submits secondary claims electronically and/or hard-copy with the necessary primary payer information.
• Researches core HIS system to root cause charge variances and establish plan to resolve accounts.
• Work special projects related but not limited to charge reconciliation and bad debt processing.
• Works time sensitive AR reports on demand.

Physical Demands

• Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time
• Weight Carried: Up to 20 lbs, Occasionally 0-30% of time
• Vision: Heavy, Constantly 66-100% of time
• Kneeling/Stooping/Bending: Occasionally 0-30%
• Standing/Walking: Occasionally 0-30%
• Pushing/Pulling: Occasionally 0-30%
• Intensity of Work: Occasionally 0-30%
• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.

NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.