Job Summary

Reviews claims and payment data to ensure accurate billing to and payments from all Commercial, Managed Care and Governmental Payers to ensure compliance with all payer contracts and fee schedules. Reviews, researches and documents trends with a focus on identifying charging and documentation opportunities. 

 

Responsibilities

Work closely with Payer Contracting Department to ensure accurate rates and payment terms are loaded in company-approved contract management systems used to monitor billing and payment activityEnsure claims and payment data is loaded into company-approved claims and payment monitoring systems and resolve any discrepancies in a timely mannerMonitor to ensure payments from contracted payers are timely and within contracted payment termsReview reimbursement and variance reports to identify trends and discrepanciesPrepare detailed non-payment/underpayment reports and distributed to appropriate teams for appropriate resolution and follow up Review denial reports to identify trends and recommend solutionsUse Company approved charge capture auditing systems to identify missed charges and work closely with various departments to resolve issue Attend meetings as required and participate on committees as requestedEnhance Professional growth and development through in-service meetings, educational programs, seminars, conferences, workshops, etc. Perform other duties and responsibilities as assigned

 

Knowledge, Skills & Abilities

Patient Group Knowledge (Only applies to positions with direct patient contact) The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department’s identified patient ages. Specifically the employee must be able to demonstrate competency in: 1) ability to obtain and interpret information in terms of patient needs; 2) knowledge of growth and development; and 3) understanding of the range of treatment needed by the patients. Competency Statement Must demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency checklist. Common Duties and Responsibilities (Essential duties common to all positions) 1. Maintain and document all applicable required education. 2. Demonstrate positive customer service and co-worker relations. 3. Comply with the company's attendance policy. 4. Participate in the continuous, quality improvement activities of the department and institution. 5. Perform work in a cost effective manner. 6. Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations. 7. Perform work in alignment with the overall mission and strategic plan of the organization. 8. Follow organizational and departmental policies and procedures, as applicable. 9. Perform related duties as assigned.

Maintain and document all applicable required education.Demonstrate positive customer service and co-worker relations.Comply with the company's attendance policy.Participate in the continuous, quality improvement activities of the department and institution.Perform work in a cost effective manner.Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations.Perform work in alignment with the overall mission and strategic plan of the organization.Follow organizational and departmental policies and procedures, as applicable.Perform related duties as assigned.

 

Education 

• Bachelor's Degree

Experience: 2 years related financial/accounting experience

 Substitution: 10 years related experience working in a Patient Accounting related position and 2 years’ experience working in an analytical role may substitute for Bachelor's Degree and 2 years financial/accounting experience

 

Credentials 

• No Certification, Competency or License Required

 

Work Schedule: Days

Status:  Full Time Regular 1.0

Location: General Hospital

Location of Job: US:WV:Charleston

Talent Acquisition Specialist: Tamara B. Young tammy.young@vandaliahealth.org