Pinnacle Healthcare Consulting LLC

Compensation

Full Description

The purpose of this position is to support PHRS’s mission, vision, core values and customer service philosophy.    Responsible for reviewing all patient balances to ensure that all insurance has been filed, coverage detection for other insurance, and account review prior to sending to the collection agency  CUSTOMER SERVICE: * Accountable for outstanding customer service to all external and internal customers. * Develops and maintains effective relationships through effective and timely communication. * Takes initiative and action to respond, resolve and follow up regarding patient billing issues with all customers in a timely manner. PRINCIPAL RESPONSIBILITIES AND DUTIES: * Responsible for reviewing all patient balances after 90 days to ensure that all insurance has been filed and processed claims * Will perform coverage detection to verify that all insurances that the patient is eligible for are filed. * Adheres to the medical practice's policies and procedures when answering the phones.  * Responds to all internal communications regarding patient accounts.  * Reviews all accounts to make sure all actions have been taken and that the balance is truly patients. * Provides accurate information to customers regarding the status of the patients’ accounts. * Makes patient payment arrangements on self-pay balances according to policies and procedures. * Processes bankruptcy notices and incorrect addresses. Ensures that patient account information is accurate and complete. * Documents activity in an accurate and timely manner on the patients’ accounts. * Maintains the appropriate proficiency and knowledge with all systems required for task completion. * Works with team leads and management to improve processes, increase accuracy, create efficiencies and achieve the overall goals of the department. * Ensures compliance with all state and federal billing regulations and reports any suspected compliance issues to the respective supervisor.  * Other duties as assigned.    PHYSICAL DEMANDS AND WORKING CONDITIONS: The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.    Employee must be able to sit at a desk for at least eight hours per day while frequently using their fingers to type. This position requires that the employee be able to speak clearly, look at and read a computer screen. Occasionally, this position may require that the employee reach or stretch for objects.  EDUCATION: * High school diploma or equivalent is required. EXPERIENCE AND REQUIRED SKILLS: * Minimum 3 years of experience medical patient billing * Candidate must understand government and managed care payment methodologies and demonstrate knowledge of terms such as contractual adjustment, allowed amount, coinsurance, denial and denial processes.   * Candidates must be familiar with state Medicaid’s and Medicare * Proven ability to maintain professional working relationships with co-workers and customers. * Knowledge of medical terminology.  * Knowledge of insurance industry and billing procedures.  * Skill in conflict resolution.  * Ability to handle multiple priorities at the same time.  * Ability to read, understand and follow verbal and written instructions. * Ability to maintain a professional attitude at all times. * Time management skills * Verbal and written communication skills * Skill in operating a computer, copier and fax machine.  * Knowledge of Microsoft Office Products SUPERVISION: None   Review and comply with the Code of Business Conduct and all relevant Company and Business Unit policies and procedures, and local, state, and Federal laws and regulations. Ensure that employees understand and comply with the Code of Business Conduct and all-relevant Company and Business Unit policies and procedures, and local, state, and Federal laws and regulations, and establish effective internal systems and controls to promote such compliance. The duties listed in this job description are intended only as illustrations of the various types of work that may be performed.  The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.  Pinnacle Healthcare Consulting is an Equal Opportunity Employer. Applicants will not be discriminated against because of race, color, creed, sex, sexual orientation, gender identity or expression, age, religion, national origin, citizenship status, disability, ancestry, marital status, veteran status, medical condition, or any protected category prohibited by local, state, or federal laws.