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Responsible for consistent insurance follow-up of any claim(s) greater than 30 days, aged from final bill date, and resolution of same in a timely and cost effective manner. This requires forming relationships with the individual insurance payers/clients in order to have the maximum response for timely and accurate payment. Monitor patient accounts assigned for accurate payment(s) or non-payment and take compliant actions for account reimbursement.
ESSENTIAL FUNCTIONS/PERFORMANCE EXPECTATIONS
· Able to read, understand and explain insurance carrier contracts and different types of reimbursement as well as accurately figure patient cost share for specific insurances.
· Able to understand, explain and handle referral/authorization issues, pre-authorization requirements, verifications, appeals, and medical necessity issues.
· Serves and protects the hospital community by adhering to hospital policies and procedures, federal, state and local requirements as well as DNV standards.
· Ability to read, understand and complete all A/R reports keeping up to date documentation of each patient account status in the patient account notes.
· Ability to respond timely to insurance and billing inquiries made in person, by mail or over the phone.
· Enhances Patient Account Department and hospital reputation by accepting ownership for accomplishing new and different requests while exploring opportunities to add value to job accomplishments.
· High School diploma or equivalency required
· Courses in insurance billing/collections and medical terminology preferred.
· One year hospital business office or physician business office experience preferred.
· Must be able to type 35 wpm and operate a personal computer with ability to use Microsoft Outlook, Excel and Microsoft Office.
· Must have basic math skills.
400 Rosalind Redfern Grover Parkway | Midland, TX 79701 | (432) 221-1111
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