Job Description

Healthcare Outcomes Performance Company is a vertically integrated musculoskeletal outcomes management company. HOPCo manages physician practices, hospital service lines, population health and value-based care programs, and musculoskeletal delivery networks.

HOPCo is the managing partner of Arizona-based entities, CORE Institute, Northern Arizona Orthopaedics, CORE Institute Specialty Hospital, Michigan-based CORE Institute, and Florida-based Southeast Orthopedic Specialists.

As HOPCo continues to grow, we are looking for a Payment and Reconciliation Specialist in our Corporate Headquarters.

ESSENTIAL FUNCTIONS:

• Has an understanding of accounts receivable posting process for medical billing including: charges, payments and adjustments.
• Posting financial transactions through use of the automated systems and team processes.
• Accurately interprets insurance explanation of benefits to ensure proper posting.
• Retrieves and uploads 835 remittance files into patient account system ensuring file reconciliation including reviewing and posting exception files.
• Participation in optimizing productivity within area.
• Maintains knowledge of the work area and optimizes use of available technology.
• Researches all information needed to process and complete insurance and/or patient refunds by obtaining information from providers, insurance plans, ancillary services staff and patients.
• Accurately processes insurance and patient refunds requests by demonstrating an advanced understanding of coordination of benefits and eligibility requirements.
• Receives and processes all refunds utilizing insurance contracts and requirements for accuracy.
• Processes and posts refund checks as received into the patient accounting system.
• Establishes and maintains effective communication with physicians, staff and other departments as required.
• Other duties as assigned by leadership.
• Adheres and understands the Business Office rules and regulations in regards to Medicare and
• HIPAA guidelines.
• Effectively forwards accounts requiring work up or resubmission to the business office staff.
• Maintains productivity and accuracy metrics per department expectations and AEIOU Behavioral Standards

The job holder must demonstrate current competencies for job position.

EDUCATION:

• High school diploma/GED

EXPERIENCE:

• A minimum of two years experience in medical billing and/or cash applications or equivalent experience in a healthcare environment.
• Prefer previous cash posting experience in a multiple lockbox environment.
• Must be able to communicate effectively with Physicians, patients and the public and be capable of establishing good working relationships with both internal and external customers.

KNOWLEDGE:

• Knowledge of revenue cycle processes.
• Knowledge of computer systems. Experience with Centricity patient management system preferred.
• Knowledge of policies and procedures with regards to physician billing processes including determining insurance eligibility and coordination of benefits.

SKILLS:

• Skill in customer service and an understanding of The CORE code of conduct and culture.
• Skill in using computer programs and Microsoft applications.
• Skill in establishing good working relationships with both internal and external customers.

ABILITIES:

• Ability to examine and interpret insurance documents including but not limited to eligibility responses and explanation of benefits (EOB).
• Ability to prepare postings and reconcile daily receipts.
• Ability to communicate clearly and effectively.
• Ability to type minimum 40 wpm.

ENVIRONMENTAL/WORKING CONDITIONS:

• Normal office environment. Some travel within community.

PHYSICAL/MENTAL DEMANDS:

• Requires sitting and standing associated with a normal office environment.
• Some bending and stretching required.
• Manual dexterity using a calculator and computer keyboard.

ORGANIZATIONAL REQUIREMENTS:

• HOPCo Mission, Vision, and Values must be read and signed.

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