Hudson Regional Hospital
Job Summary
Responsible for the timely and accurate resolution of insurance claims, primarily for Medicare, Medicaid, and HMO plans. This role involves follow-up on claims from billing through final resolution, identifying and correcting errors, and ensuring prompt payment of outstanding accounts. Key Responsibilities
Claim Follow-up
Monitor the progress of insurance claims from submission to payment Payers include Medicare, Medicare HMO's, Medicaid and Medicaid HMO's Identify and resolve claim denials, rejections, and delays. Follow up with insurance carriers to expedite claim payments.
Error Correction
Review daily electronic billing reports, paper claim submissions, and third-party confirmation reports for errors. Make necessary corrections in the billing system to ensure accurate claims.
Medicare Claims
Process Medicare RTP claims and denial reports on a daily basis. Ensure timely and accurate submission of Medicare credit balance quarterly reports.
Account Resolution
Research outstanding accounts and take appropriate action to secure prompt payment. Analyze system-generated reports to identify accounts requiring research. Document all resolution activities in the appropriate system and log. Alert supervisors or managers of non-payment trends.
Contractual Allowance
Research partial payments to determine if the appropriate contractual allowance was calculated. Initiate corrective action for miscalculated allowances, including collaboration with clinical departments. Document results and alert supervisors or managers of trends.
Rejected and Denied Services
Research rejected or denied services and determine corrective action. Complete corrective action using departmental procedures and policies. Document results and alert supervisors or managers of non-payment trends.
Reporting
Complete productivity reports and submit to supervisors within the established timeframe.
Customer Service and Performance Improvement
Support the department's customer service and performance improvement goals. Collaborate with other staff to enhance patient care and service.
Compliance
Maintain strict confidentiality of patient information.
Required Qualifications
Experience: 1-3 years of experience in healthcare billing or Hospital billing. Technical Skills: Proficiency in using billing systems and software. Knowledge: Knowledge of Medicare, Medicaid, and HMO billing regulations.
Responsible for the timely and accurate resolution of insurance claims, primarily for Medicare, Medicaid, and HMO plans. This role involves follow-up on claims from billing through final resolution, identifying and correcting errors, and ensuring prompt payment of outstanding accounts. Key Responsibilities
Claim Follow-up
Monitor the progress of insurance claims from submission to payment Payers include Medicare, Medicare HMO's, Medicaid and Medicaid HMO's Identify and resolve claim denials, rejections, and delays. Follow up with insurance carriers to expedite claim payments.
Error Correction
Review daily electronic billing reports, paper claim submissions, and third-party confirmation reports for errors. Make necessary corrections in the billing system to ensure accurate claims.
Medicare Claims
Process Medicare RTP claims and denial reports on a daily basis. Ensure timely and accurate submission of Medicare credit balance quarterly reports.
Account Resolution
Research outstanding accounts and take appropriate action to secure prompt payment. Analyze system-generated reports to identify accounts requiring research. Document all resolution activities in the appropriate system and log. Alert supervisors or managers of non-payment trends.
Contractual Allowance
Research partial payments to determine if the appropriate contractual allowance was calculated. Initiate corrective action for miscalculated allowances, including collaboration with clinical departments. Document results and alert supervisors or managers of trends.
Rejected and Denied Services
Research rejected or denied services and determine corrective action. Complete corrective action using departmental procedures and policies. Document results and alert supervisors or managers of non-payment trends.
Reporting
Complete productivity reports and submit to supervisors within the established timeframe.
Customer Service and Performance Improvement
Support the department's customer service and performance improvement goals. Collaborate with other staff to enhance patient care and service.
Compliance
Maintain strict confidentiality of patient information.
Required Qualifications
Experience: 1-3 years of experience in healthcare billing or Hospital billing. Technical Skills: Proficiency in using billing systems and software. Knowledge: Knowledge of Medicare, Medicaid, and HMO billing regulations.