Tri-City Medical Center
PAYER ANALYST REPORT & RECOVERY - NON-GOVERNMENT ACCOUNTS
Tri-City Medical Center, Oceanside, California, United States, 92058
Overview
PAYER ANALYST REPORT & RECOVERY - NON-GOVERNMENT ACCOUNTS Join to apply for the PAYER ANALYST REPORT & RECOVERY - NON-GOVERNMENT ACCOUNTS role at Tri-City Medical Center. Location: Oceanside, CA (US-CA-Oceanside). Tri-City Medical Center has served San Diego County’s coastal communities for more than 60 years and is one of the largest employers in North San Diego County. The hospital is administered by the Tri-City Healthcare District and operates as a full-service acute care public hospital with a focus on safe and effective patient care. Position summary: This position is responsible for ensuring all billing and collecting of claims is completed accurately, timely and according to all guidelines and requirements to ensure proper reimbursement. Follows up and follows through to resolve underpaid and denied accounts. Utilizes the system to follow up on underpayments and denials to secure payment. Demonstrates extraordinary commitment to excellence by adhering to departmental excellence criteria. Major Position Responsibilities
Maintain a safe, clean working environment, including unit-based safety and infection control requirements. Meet collection goals established by the department leadership. Utilize QMS to reach daily and weekly goals. Represent Tri-City Medical Center when claims need to be researched with insurance companies by phone or Internet to verify payment, denial, and patient or guarantor eligibility. Ensure that all insurance payments and discounts are applied and any remaining balance is transferred to patient liability, if applicable. Take initiative to bring forward process/performance improvements as identified. Perform special assigned duties to meet the needs of the department. Update patient demographic and insurance information in the patient accounting system. Identify trends and report to the Supervisor and Manager. Attach supporting documentation to claims and verify/update insurance information as required, including updating payer information, refreshing and re-triggering claims, and changing bill dates. Document steps taken while working accounts in the notes screen, including contact names and telephone numbers. Attend and contribute to departmental meetings; distribute new and updated information and provide input to the organization. Rebill insurance claims by paper and electronic processes. Audit accounts for missed payments, adjustments, and remark codes. Review, audit and collect on underpaid or denied insurance claims and stop-loss accounts according to contracts and guidelines to ensure proper reimbursement when rebilling a claim. Write and work letters of appeals for all denied or underpaid claims and handle assigned correspondence within 48 hours of receipt. Collaborate with Medical Records, Clinics, and Business Office focusing on payer-specific CPT & ICD codes for appropriate reimbursement. Review denial codes by report in the patient accounting system for accuracy and trends. Qualifications
Three years of hospital and/or Medical Office billing and/or collection experience is required. Verbal and written communication skills sufficient for effective interaction with carriers and patients. Knowledge of and experience in basic follow-up and collection techniques. Typing skills of 35-45 wpm. Good written and verbal communication skills as well as analytical capabilities. Business office skill sets and ability to work with staff to resolve patient accounting system issues. Intermediate to advanced experience with Microsoft Office Suite, specifically Word and Excel, and Microsoft Windows. Ability to analyze problems and develop solutions; capable of determining appropriate methods and task sequences. Ability to organize and manage large volumes of information using Microsoft Excel. Reading comprehension skills to understand payer contracts. Knowledge of payment and coverage practices and terminology used by contracted payers. Education
High School diploma or GED, required. Associates degree or higher from an accredited university, preferred. Each new hire candidate who is offered employment must pass a physical evaluation, urine drug screen and pre-employment background checks before starting work. Salary/hourly wage range for this position is posted. Actual pay will be determined based on verified experience and internal equity. TCHD is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, age, marital status, status as a protected veteran, disability status, or other protected characteristics.
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PAYER ANALYST REPORT & RECOVERY - NON-GOVERNMENT ACCOUNTS Join to apply for the PAYER ANALYST REPORT & RECOVERY - NON-GOVERNMENT ACCOUNTS role at Tri-City Medical Center. Location: Oceanside, CA (US-CA-Oceanside). Tri-City Medical Center has served San Diego County’s coastal communities for more than 60 years and is one of the largest employers in North San Diego County. The hospital is administered by the Tri-City Healthcare District and operates as a full-service acute care public hospital with a focus on safe and effective patient care. Position summary: This position is responsible for ensuring all billing and collecting of claims is completed accurately, timely and according to all guidelines and requirements to ensure proper reimbursement. Follows up and follows through to resolve underpaid and denied accounts. Utilizes the system to follow up on underpayments and denials to secure payment. Demonstrates extraordinary commitment to excellence by adhering to departmental excellence criteria. Major Position Responsibilities
Maintain a safe, clean working environment, including unit-based safety and infection control requirements. Meet collection goals established by the department leadership. Utilize QMS to reach daily and weekly goals. Represent Tri-City Medical Center when claims need to be researched with insurance companies by phone or Internet to verify payment, denial, and patient or guarantor eligibility. Ensure that all insurance payments and discounts are applied and any remaining balance is transferred to patient liability, if applicable. Take initiative to bring forward process/performance improvements as identified. Perform special assigned duties to meet the needs of the department. Update patient demographic and insurance information in the patient accounting system. Identify trends and report to the Supervisor and Manager. Attach supporting documentation to claims and verify/update insurance information as required, including updating payer information, refreshing and re-triggering claims, and changing bill dates. Document steps taken while working accounts in the notes screen, including contact names and telephone numbers. Attend and contribute to departmental meetings; distribute new and updated information and provide input to the organization. Rebill insurance claims by paper and electronic processes. Audit accounts for missed payments, adjustments, and remark codes. Review, audit and collect on underpaid or denied insurance claims and stop-loss accounts according to contracts and guidelines to ensure proper reimbursement when rebilling a claim. Write and work letters of appeals for all denied or underpaid claims and handle assigned correspondence within 48 hours of receipt. Collaborate with Medical Records, Clinics, and Business Office focusing on payer-specific CPT & ICD codes for appropriate reimbursement. Review denial codes by report in the patient accounting system for accuracy and trends. Qualifications
Three years of hospital and/or Medical Office billing and/or collection experience is required. Verbal and written communication skills sufficient for effective interaction with carriers and patients. Knowledge of and experience in basic follow-up and collection techniques. Typing skills of 35-45 wpm. Good written and verbal communication skills as well as analytical capabilities. Business office skill sets and ability to work with staff to resolve patient accounting system issues. Intermediate to advanced experience with Microsoft Office Suite, specifically Word and Excel, and Microsoft Windows. Ability to analyze problems and develop solutions; capable of determining appropriate methods and task sequences. Ability to organize and manage large volumes of information using Microsoft Excel. Reading comprehension skills to understand payer contracts. Knowledge of payment and coverage practices and terminology used by contracted payers. Education
High School diploma or GED, required. Associates degree or higher from an accredited university, preferred. Each new hire candidate who is offered employment must pass a physical evaluation, urine drug screen and pre-employment background checks before starting work. Salary/hourly wage range for this position is posted. Actual pay will be determined based on verified experience and internal equity. TCHD is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, age, marital status, status as a protected veteran, disability status, or other protected characteristics.
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