Essential Job functions:
· Monitoring and working the workflow dashboard for assigned providers and specialties, to include researching and correcting claims on MGRHOLD, writing appeals and facilitating their submission by Athena for appealing adverse decisions, contacting payers and Medical Directors as needed, and all other activities that lead to the successful adjudication of eligible claims.
· Oversight of HOLD and monitoring of MISSING SLIPS for assigned providers and specialties.
· Any coding and charge entry based on assigned providers and specialties.
· Completing claims worklists assigned by Reimbursement Supervisor.
· Bi-monthly reporting of dashboard status to Reimbursement Supervisor via Excel spreadsheet or other template to include aged since last touch balances and error reasons.
· Run reports for distribution to the physician and physician staff as needed to communicate data of interest, work performed, or ad hoc.
· Complete system knowledge, ability to run reports, worklists, and research and resolve an assigned subset of Unpostables, payment batches.
· Responsible for running the Zero Pay Worklists at a minimum of bi-weekly for assigned providers and specialties, reviewing and responding to adjustments with approval or appeal.
· Field Patient Accounts staff or practice-based patient balance due questions and complaints as well as insurance needs on behalf of assigned providers and specialties.
· Receive transferred calls or emails from Patient Accounts staff with patient's requesting advanced assistance with their account.
· Illustrate excellent knowledge of healthcare industry in regard to the revenue cycle, coding, claims and state insurance laws.
General Job functions:
· Expert in athenaCollector co-sourcing model.
· Expert in management and resolution of items in the MGRHOLD bucket:
· Rules versus denials
· Kickcodes – what they are and what they do
· Claim note history including actions and claim statuses
· Expert in Oversight and Guidance/Management of HOLD bucket and Missing Tickets for assigned AR.
· Expert in EOBs and ERA and what they mean in athenaNet.
· Expert in Communication
· Claim notation
· Physician and Practice location staff
· Appeals and Payers
· Athena CSC and athenaNet
· Expert in sorting work queues and Worklists:
· Zero Pay
· Fully Worked Receivables
· Claim Attachment Error Queue
· Payment Mismatch
· Unpostables worklists/dashboard research and resolution
· Unapplied Worklist
· Expert in generally accepted insurance benefit terms and processes
· Expert in interpretation of billing slips for claim/code creation
· Facility-based charge entry
· Expert in Quickview, Registration, and Claim Edit screens. All screens, tools and data locations available under the user's security access.
· Expert in request/preparation of supporting documentation such as medical records, dictation, appeal letters, contract pages.
· Expert in patient balance policies, workflows, and tools.
· Expert in management of TOS payment need(s):
· DAILY process of opening, closing and reconciling payment/deposit batches.
· Expert in investigation and Denial/Appeal/Preparation of Refunds:
· Expert in reporting, Activity Wizard, AR Wizard, Report Builder and any available reports in Library or through other means in Athena:
· Expert in customer service to patients and Physicians/Staff.
· Familiar with Patient 5 Stage Workflow Concept.
· Familiar with Registration, Scheduling, Check In and Check Out, pre-view and Day End Review, and other procedures, processes, and tools both in SMG policy and athenaCollector.
Physical Job Requirements:
- Dexterity of hands and fingers
- Endurance (e.g. continuous typing, prolonged standing/bending, walking)
Education, Certification, Computer and Training Requirements:
- High School Graduate/GED required. Associate's or Bachelor's degree preferred.
- 5-8 years experience required.
- Ability to communicate in English, both orally and in writing required.
- Strong planning and organizational skills required.
- Strong attention to detail and customer service skills required.
- Strong problem solving and decision making skills required.
- Experience with athenaCollector and Anodyne preferred.
- Experience with Standard Office Technology in a Window based environment. Experience with Microsoft Word and Excel required.
- Experience with Standard Office Equipment (Phone, Fax, Copy Machine, Scanner, Email/Voice Mail) required.
· Familiar with modifiers, CPT, and ICD-9 resources in Athena.
· Familiar with the process of credentialing.
· Familiar with Physician staff, practice habits, preferences of communication.· Familiar with New Jersey State Insurance Laws.