Serves as the main contact for all patient/families, third parties, and related Lurie Children's departments, analyzing and resolving all billing, collection, and customer inquiry needs. Responsible for the timely and accurate resolution of hospital accounts. Routinely uses the patient accounting system, electronic claims systems, office software, verbal and written skills to expedite resolution of claims and issues.
1. Researches and analyzes account information such as: authorization/certification received; benefit verification for completeness and accuracy of billing; coding structures meeting the payer regulations and corresponding to the appropriate billing form; procedural and diagnostic coding; posting of automatic contractual allowances per the payer agreements. Identifies and resolves recurring problems that delay the submission/resolution of an accurate bill.
2. Ensures claims are received by payers / guarantors in a timely and accurate fashion. Ensures all information is accurate and compliant with industry and federally mandated standards.
3. Initiates written and/or verbal inquiries with third party payers, patients and guarantors to secure payments of the balances due. Completes account documentation to provide a clear audit trail to support all collection activity. Exhausts all available resources in an effort to expedite the payment of account balances.
4. Analyzes account detail and utilizes available resources (contract information) to ensure that proper reimbursement from third party payers has been calculated, received and/or is still due. Verifies that adjustments have been applied and the balance due is correct.
5. Responds to all inquiries (phone, written correspondence or personal visit) and resolves any issues when appropriate by performing billing, charge revision (debits or credits), corrections, adjustment, payment arrangements, discounts, and settlements ensuring a customer satisfactory interaction.
6. Communicates with all payers in accordance with Lurie Children's policies in order to resolve accounts. Documents actions taken and account statuses in the appropriate hospital system so that all staff working an account are aware of the information.
7. Ensures reimbursement is maximized through exhausting all internal efforts towards resolution of a claim. Performs due diligence as outlined by department policies and procedures.
8. Performs other job-related tasks as assigned by Patient Financial Services management.
9. Performs job functions adhering to service principles with customer service focus of innovation, service excellence and teamwork to provide the highest quality care and service to our patients, families, co-workers and others.
1. High school graduate required; two years of college preferred.
2. Minimum of three years of business office experience in hospital or physician office setting with significant time spent in communication with patients/families and third party payers.
3. Knowledge of windows-based personal computers is required and experience with electronic claims editing software preferred.
4. Demonstrates effective utilization of the features of the telephone system in order to achieve greater productivity with appropriate collection practices and techniques. Familiarity with medical terminology is helpful.
5. Thorough knowledge of patient accounting, third party payer procedures, governmental regulations and managed care contracting to be effectively proactive in the billing and collection process, and to respond to inquiries on patient accounts in a customer satisfaction manner.