Patient Account Specialist Lead - Specialty Orthopedic Surgery - Full Time

Summary:

Provides medical collection services for TLRA collection units. Utilizes a strong background as a medical collection specialist to successfully resolve accounts placed with TLRA for collection.

This involves performing collection activities related to follow-up and account resolution and includes communication with patients, clients, reimbursement vendors, and other external entities while adhering to all client, state, and federal guidelines. Patient and client satisfaction is essential. Associates in the collection units are expected to knave knowledge of the overall collection work processes for both active AR and BD inventory.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Provides effective collection services, ensuring the successful recovery of accounts in accordance with client and state guidelines as well as TLRA's business objectives.
• Understands and adheres to all policies and procedures, as well as local, state, and federal regulations, relevant to their area of operation.
• Documents and updates patient account information in TLRA's collection software system timely and accurate to include appropriate account status.
• Handles inbound patient and/or carrier calls promptly and professionally, providing assistance and resolution to account inquiries, issues, and request.
• Uses collection tools effectively to ensure quality recovery services and meet or exceed established goals and work standards.
• Performs research and analysis of account issues and strives to resolve problems timely and accurately.
• Ensure daily productivity standards are met.
• Promotes positive patient relations by communicating in a manner that demonstrates respect for the human dignity of patients and/or their families.
• Thorough understanding of Medicare/Medicaid guidelines and procedures for billing, collections, and appeals.
• Understanding and exposure to Medicare Recovery Audit Contractor.
• Knowledgeable in locating and referencing CMS and/or Medicare Regulations.
• General hospital A/R accounts knowledge is required.
• Solid knowledge and utilization of desktop applications including Word and Excel are essential.
• Performs other special projects as required when assigned.

Collections - Traditional Government Insurance

• Maintains active knowledge of all collection requirements by payors.
• Collects balance owing from third-party payers in accordance with State and Federal laws governing collections practices. Ensures that collection efforts are thorough with the overall objective being to collect outstanding balances in an ethical manner.
• Ensures established quality standards are met and proper documentation regarding patient accounting records.
• Contact other departments to obtain necessary information for appeals, pending information, and any other issues that impact and/or delay claim processing.
• Provides effective and timely collection services ensuring the successful recovery of accounts in accordance with client and state guidelines as well as TLRA's business objectives.
• Validates claim payments to ensure claims are paid according to contract and/or payment methodology guidelines.
• Correct claims in RTP status in either CCSM or DDe per Medicare guidelines.
• Initiate Medicare Redetermination, Reopening, and/or Reconsideration as needed.

Job Requirements:

Education/Skills

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  High School or equivalent years of experience required.

  
  

Experience

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  5 - 7 years of experience preferred.

  
  
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  Experience with the Medicare billing process.

  
  
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  College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.

  
  

Licenses, Registrations, or Certifications

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  None required.

  
  

Work Type:

Full Time