Position Description

OCCUPATIONAL SUMMARY

 

Calculates and reconciles contractual adjustments that are required for all HMO, PPO, and contracted groups including Worker’s Compensation and Champus. Also responsible for submission of overpayments to the payers and for the notification of any patient overpayments.

 

PRIMARY DUTIES AND RESPONSIBILITIES

Reviews E.O.B. and remittance advices for contracted accounts to ensure the appropriate payment was received from the payer. Determines contractual adjustments for those contracted accounts not adjusted at final bill by reviewing E.O.B./Remittals when payment is received. Changes financial classes on accounts with patient liability balances, secondary insurance balances and account denials. Controls money movements on the patient’s accounts to ensure that the correct balances are maintained at all times. Corrects any misapplied payments that occur. Reviews and researches credit balances to determine if the credit is related to a patient or insurance overpayment and takes the appropriate action to resolve the credit. Reviews account receivables and bad debt accounts for outstanding balances and makes the appropriate transfer. Transfers misapplied payments to the appropriate accounts. Prepares refunds, transfer adjustments, or other appropriate forms when necessary, and submits them to the supervisor for approval. Practices proper safety techniques in accordance with hospital and departmental policies and procedures. Immediately reports any mechanical or electrical equipment malfunctions, unsafe conditions, or employee/patient/visitor injury‑accident to Manager.

Position Requirements

REQUIRED:

One (1) year experience in patient accounting or healthcare reimbursement, or Associates Degree in Business or related field. Must be able to perform basic mathematical calculations Good oral and written communication skills Demonstrated knowledge of ten (10) key calculators, and personal computers and computer spreadsheet programs.

PREFERRED:

Prior experience interpreting UBO4 billing documents, EOB remittances against managed care contracts, and adjustment processing. General knowledge of HMO/PPO contracts and credit balances Basic knowledge of hospital terminology applicable to patient billing.

Service Area Overview