The Ambulatory Surgery Division operates over 100 ambulatory surgery centers' across the U.S. Ambulatory Surgery Centers (ASCs) perform surgeries that do not require hospital admission. They provide cost-effective services and a convenient environment. Procedures are performed in a fully equipped operating room and recovery is under the care of highly skilled nurses. Whether young or old or somewhere in between, patients and their families benefit from the comfortable environment ASCs have to offer. Surgeries performed include eye, ear, nose and throat (ENT), general surgery, gynecologic, plastic surgery, podiatry and orthopedics. Apply Now! Come Join our Team! GENERAL SUMMARY OF DUTIES:
Contributes to the company completing the follow-up and collection from third party payers and self pay accounts to enhance cash flow and obtain associated reimbursement based on established contracts. DUTIES INCLUDE BUT ARE NOT LIMITED TO:
Qualifications: KNOWLEDGE, SKILLS & ABILITIES:
- Performs follow up activities on all accounts to ensure prompt payment.
- Maintains daily queue on desktop.
- Identifies and corrects any coding or billing problems from EOBs.
- Monitors insurance claims by running appropriate reports and contacting insurance companies to resolve claims that are not paid in a timely manner.
- Prepares accounts for rebilling and for filing secondary insurance; sends to carrier with necessary documents, as needed.
- Completes filing and follow-up on insurance denials with coder and physicians to obtain reimbursement.
- Handles patient and insurance inquiries.
- Updates the patient account record to identify actions taken on the account.
- Updates AdvantX using daypack and re-files claims, as required.
- Assigns Bad Debt accounts to Collection Agency as approved by BOM.
- Acts as a liaison in collection of third party accounts, as required per Center practices.
- Completes the reconciliation of accounts that are turned over to outside agencies.
- Administers Center contracts with third party payers including Medicare and Medicaid, in accordance with facility practices, as determined through facility processes.
- Notifies BOM/Administrator of contractual issues that are contrary or inconsistent with contract language.
- Negotiates payment plans on self pay accounts utilizing established policies regarding Settlement Discounts.
- Completes weekly reporting to BOM and Administrator involving collections.
- Responsible for achieving and maintaining accounts receivable days at the established ASD goal.
- Responsible for the reduction and maintenance of bad debt at the established ASD goal.
- Performs reviews and turnovers of aged accounts to an outside collection agency for 1st placements and bad debt.
- Follows Best Practices regarding initial follow-up at 21- 28 days for insurance claims and subsequent follow-up every 14-21 days.
- Answers telephones.
- Attends required meetings and participates in committees.
- Provides business office and admissions back up as needed.
- Other duties as assigned based on business operational needs.
- Organization - Proactively prioritizes needs and effectively manages resources and time.
- Communication - Communicates clearly, concisely, and professionally.
- Analytical Skills - Demonstrates ability to critically evaluate and appropriately act upon information.
- Customer Orientation -Maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
- Decision Making - Identifies issues, problems, and opportunities; compares data from different sources to draw conclusions; uses effective approaches for choosing a course of action or develops appropriate solutions; takes action that is consistent with available facts, constraints, and probable consequences.
- Contributing to Team Success - Actively participates as a member of the Center's team to move the team toward the completion of goals.
- Policies & Procedures - Articulates knowledge and understanding of organizational policies, procedures, and systems.
- PC Skills - Demonstrates proficiency in Microsoft Office (Excel, Word, and Outlook) applications; knowledge of, or ability to learn, AdvantX - Accounts Receivable System, Smart, HOST and other systems as required. Demonstrates ability to type on PC keyboard.
- Technical Skills -
- Knowledge of commercial, Medicare, Medicaid, HMO/PPO, Tricare insurance operating procedures and contracts, and basic medical terminology.
- Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly, and transcribe accurately.
- Minimum (1) year of experience in a medical office setting (i.e. ambulatory surgery center, hospital, doctors office) highly preferred.
- Knowledge of managed care payers and medical terminology (preferred).
- Basic Life Support (BLS) may be required as per facility standard.
A little about us:
HCA is the nation’s leading private provider of healthcare services. Comprised of locally managed facilities which include 230,000 employees at over 160 hospitals, over 120 surgery centers and 100 urgent care facilities in 20 states and the United Kingdom