Job Details

Inspire health. Serve with compassion. Be the difference.

Job Summary
Responsible and accountable for accurate and timely follow up, including variances, no payments, denials for all payers on billed accounts receivable. Ensures accounts are followed up on in a timely manner with diligent focus on all including, but not limited to aged and high dollar accounts. Follows up and pursues identified payer variances after comparing expected to actual reimbursement received. Responsible for working with other departments when issues arise such as missing payments, payer delays, and technical denials. Demonstrates exceptional relationships with external payers and internal departments in accordance with Prisma Health Standard of Behaviors and Compliance.

This is a remote position.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.
• Analyses and reviews prior account activity and takes necessary actions including calling payer or utilizing payer websites for current status of outstanding accounts receivable (AR). Takes necessary actions to correct claim or obtain any requested information to the payer. Utilizes all appropriate workflows and completes appropriate and detail notes on every account preparing for next steps and/or resolution.
• Performs daily duties related to collections, variances and/or technical denials in a manner that constantly drives the account towards resolution, while challenging unacceptable responses from payers. Understands, interprets and applies managed care contract terms to accounts for payer resolution.
• Escalates accounts when appropriate, including but not limited with payer, internally and/or patient when appropriate in accordance with the Prisma Health escalation guidelines in order to minimize aging.
• Identifies trends and repeated problems and/or charge corrections to management.
• Contributes to PFS department matrix. Utilizes time and resources, assisting co-workers as time allows.
• Productivity and quality of work must be met. Identifies areas for improvements. Monitors quality levels, identifies root cause of quality problems and owns/acts on quality problems.
• Performs other duties as assigned.

Supervisory/Management Responsibilities

• This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements

• Education - High School diploma or equivalent OR post-high school diploma/highest degree earned
• Experience - Two (2) years medical billing, customer service, follow up and/or medical office experience.

In Lieu Of

• NA

Required Certifications, Registrations, Licenses

• CRCA preferred.
• CRCR preferred.

Knowledge, Skills and Abilities

• Communication skills
• Understands, promotes and adheres to all matters of compliance with laws and regulations.
• Maintains professional growth and development through seminars, workshops, in-service meetings, current literature and professional affiliations to keep abreast of latest trends in field of expertise.
• Medical billing, follow up and/or medical office skills
• Analytical skills
• Attention to detail

Work Shift
Day (United States of America)

Location
Corporate

Facility
7001 Corporate

Department
70019122 PBO-Patient Account Services

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.