Prisma Health

Compensation

Full Description

Inspire health. Serve with compassion. Be the difference. Job Summary Responsible for monitoring and/or resolution of high dollar, high profile, escalated accounts. Ensures timely and accurate posting, adjustments, correspondence, and/or denials. Ensures complete, accurate, and compliant processes resulting in optimal collection and customer service performance for the organization. Supports various special projects ensuring billing, AR, and denial prevention are optimal. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference. Monitors, research and/or resolves high dollar, high profile, and problem accounts, providing necessary information to various internal revenue cycle departments, clinical and corporate departments, and patients for resolution of account inquiries. Monitors, reviews and provides analysis of all assigned work queues, dashboards and watch lists, payer communications and analysis, identifying trends and working with other departments to resolve system issues. Demonstrates superior communication skills necessary for developing and maintaining positive professional relationships with team members, revenue cycle departments, clinical and corporate departments, payers, and industry organizations. Evaluates payer performance and payment trends to provide management with valuable statistics to facilitate improved payer relations and contracting criteria, identifies payer specific problem trends and works with clinical departments, outcomes management, managed care, reimbursement and PFS to rectify systematic issues. Facilitates, attends and/or participates in payer assigned meetings for improved payer relations and to identify and resolve payer processing, claims and denial issues. Assures timely communication of all meeting outcomes to appropriate PFS team members. Attends appropriate meetings and training seminars to assure awareness and understanding of all billing regulations, compliance policies, industry changes, and/or payer reimbursement guidelines. 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. Recommends and assists in the development of regular training sessions with team members, to ensure highest quality and productivity standards are achievable. Assists in on boarding of new team members as well as providing ongoing support for all FS team members. Identifies payer specific trends and works with revenue cycle, clinical and corporate departments, managed care and reimbursement teams on resolution. Maintains strict adherence to department quality measures and timely and accurate completion of assigned responsibilities Responsible and accountable for reconciliation and accuracy of vendor invoices, vendor staff set up in EPIC, vendor collection and expense reports. Meets and exceeds the appropriate performance and productivity standards and key performance indications for the department. Demonstrates accurate and professional relationships with all Prisma Health patient accounts, ancillary departments and third party payers in accordance with Prisma Health Service Excellence, Standard of Behaviors and Compliance. 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 - Five (5) years revenue cycle, accounting experience including registration, billing, collections, credits, refunds, customer service, banking, finance, managed care or related area In Lieu Of NA Required Certifications, Registrations, Licenses CRCA preferred CRCR preferred Knowledge, Skills and Abilities NA Work Shift Day (United States of America) Location Colonial Life Building Facility 7001 Corporate Department 70019935 System Billing Office 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. Prisma Health is the largest not-for-profit health organization in South Carolina, serving more than 1.2 million patients annually. Our 32,000 team members are dedicated to supporting the health and well-being of you and your family. Our promise is to: Inspire health. Serve with compassion. Be the difference.