Website Rehabilitation Hospital of Indiana (RHI)
This listing is about Rehabilitation Hospital of Indiana RHI in Indianapolis, IN
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About the job
- SUMMARY/PURPOSE OF JOB
RHI has created a unified Patient Financial Services department with revenue cycle responsibility for all aspects of cash posting, insurance clearance, insurance billing and collection. This position is responsible for patient claim review, bill editing and submission, payment follow-up, denials management, credit balances and payment posting. The incumbent is expected to function as part of the RHI revenue management team and meet performance standards for all assigned duties.
Team members will understand and exhibit the principles of service excellence, lead by example, and mentor others in the performance of their assigned duties. Additionally, understand that every employee is responsible for exhibiting exceptional customer service by answering call lights on the nursing unit and if not able to assist personally, they will inform the appropriate employee regarding the patient’s need.
Team members are expected to understand the role of an employee’s individual position regarding HIPAA requirements and level of access to Protected Health Information as defined in HIPAA hospital-wide policies.
Understands that it is the responsibility of every RHI staff member to provide patient safety as a priority response according to Rl evidence based practices. Encourage patients to be actively involved in their own care as patient safety strategy.
JOB DUTIES/ESSENTIAL FUNCTIONS
PRIMARY JOB DUTIES/ESSENTIAL FUNCTIONS
- Claim scrubbing
- Understands payer requirements to process clean claims
- Performs pre-bill claim audits
- Prints non-electronic claims and mails out the same day.
- Processes Blue Cross, Medicaid, Medicare, and other commercial insurance claims using appropriate revenue codes for the claim. Reviews accounts which were rejected due to improper codes by reviewing and/or obtaining the proper ICD9 and CPT codes for the claim. Completes rejected claims properly and submits to the insurance carrier.
- Prepares claims for third party submission according to the insurance policy coverage guidelines
- Reviews the delinquent account work list for accounts with balances over 45 days old. Follows up and collects accounts. Reviews the work lIst for Medicare and workers compensation accounts over 30 days old.
- Follows up and collects all secondary bills. Makes contact with insurance companies to collect delinquent accounts by phone. Sets up a schedule for patients to pay large balances on accounts according to hospital policy. Rebills as necessary.
- Analyzes patient accounts with credit balances to determine adjustments or refunds required.
- Compiles Medicare balance report quarterly
- Works with Blue Cross credit balance auditors on payment corrections
- Submits necessary paperwork to Accounts Payable for processing refund checks as necessary
Payment and adjustment posting
- Post electronic payments daily; balances to the check amount
- Manually posts PNC lockbox balancing to the deposit amount
- Manually posts all adjustments requests submitted by billing personnel.
- Utilizes the accurate contractual adjustment code
- Employee is focused on providing customer satisfaction (including, but not limited to, patients, co-workers, visitors, vendors and physicians) as a primary goal/outcome of all interactions; places customer first in the performance or lob duties and responds to needs in a timely manner as evidenced of the absence or legitimate customer complaints.
- Participates in continuous quality improvement programs evaluation activities and observes measures to ensure Hospital, Joint Commission, CARF and other quality standards and regulations are met.
- Uses appropriate technique in performing duties to avoid or minimize accidents and injury related to unsafe practice. Proactively seeks information and resources, including the Environment of Care Manual. to aid in safe performance of duties to contribute to the RHI culture of safety.
- Other duties as assigned.
EFFECT OF ERRORS
IN PERFORMING PRIMARY JOB DUTIES/ESSENTIAL JOB FUNCTIONS
Errors in patient charging and collection could result in a serious loss of income to the Hospital as well as damage to the patient’s credit rating, door public relations and possible legal action against the Hospital. Improperly coding insurance documents could cause severe financial impact since all billings go through this position for proper payment codes. Wrong codes could result in incorrect reimbursement or a Medicare audit causing heavy penalties and loss of provider membership. Poor communications with patients or insurance company representatives could result in a poor image of the Hospital, dissatisfaction of the patient, and possible loss or business
NECESSARY TO PERFORM PRIMARY DUTIES/ESSENTIAL JOB FUNCTIONS KNOWLEDGE, SKILLS, ABILITIES
- Requires general knowledge and understanding of departmental activities and procedures. Requires knowledge of where to obtain required data to process claims
- Minimum three years of experience in a health care environment working in either physicians office or hospital setting working with insurance verification, insurance billing and collections from governmental and third party payers. Additional experience with self pay collections is helpful. Billing/coding externship will be considered.
SPECIAL TRAINING, LICENSURE, CREDENTIALING
- High school graduate or equivalent. Medical terminology preferred.
- Knowledge of general office equipment
ADDITIONAL QUALIFICATIONS TO SUPPORT PERIPHERAL JOB DUTIES
- Contact with departmental personnel, physicians’ offices, nursing units, admitting personnel for the purpose of securing routine information necessary to complete claim
- Extensive patient and payer contact
REPORTS TO: Team Lead Patient Financial Services
DIRECTLY SUPERVISES: None
INDIRECTLY SUPERVISES: None
RISK CATEGORIES RELATED TO OSHA BLOODBORNE PATHOGENS AND NEEDLESTICK PREVENTION
- Risk Category I – highest potential for exposure
- Risk Category II – moderate potential for exposure
- Risk Category III – unlikely contact for exposure
Company: Rehabilitation Hospital of Indiana (RHI)
Job Location: Indianapolis, IN
Application Deadline: N/A
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