General Summary of Position Responsibility:
Responsible for the application to the appropriate patient account any payments received electronically or hard copy from patients, guarantors, insurance companies, and other third party payers. Reviews contractual adjustments taken by managed care payers, and researches and resolves any differences. Responsible for distributing payments received by PFS but which are intended as payments for other CMH entities. Generates appropriate documentation to the Accounting Department to account for all cash transactions related to patient accounts receivable.
Essential Job Functions:
- Applies payments received electronically or hard copy from patients, guarantors, insurance companies, and other third party payers to the appropriate patient accounts.
- Prepares journal entries with appropriate documentation to the Accounting Department for all journal entries related to patient accounts receivables.
- Reconciles Blue Cross Experience Report.
- Using Managed Care contract terms and governmental reimbursement regulations, corrects any erroneously posted system-generated or manual contractual adjustments taken prior to the time of payment, and posts any appropriate contractual adjustments not posted prior to the time of payment.
- After reviewing the accuracy of payments and adjustments posted to the account, and after ensuring the accuracy of amounts pro-rated to third parties and the the patient, determines the next step in pursuing any remaining balance, and provides the necessary data to the person responsible for the next step in following up on remaining balances.
- Completes processing of all refunds within established time frames. Handles all refund checks returned to CMH as unprocessed due to incorrect address or other reasons. Researches and resolves (including initiating stop payment requests) any refund checks not received by the intended recipient.
- Processes all patient or third party checks returned as unpayable due to insufficient funds.
- Receives, reconciles, and deposits window cash, mail cash, and departmental cash.
- Performs other job-related tasks as assigned.
Knowledge, Skills and Abilities:
- High school graduate, with two years of college preferred. Accurate math/accounting practices.
- Experience with electronic remittance advice software preferred. Four years of cash application experience required.
- Ability to enter or key high volumes of data rapidly and accurately required.
- Sufficient knowledge of patient financial service systems to effectively perform necessary transactions on patients’ accounts and for general ledger journal entries.
- Familiarity with windows-based computer systems desired.