Ambulance Revenue Cycle Specialist 1

Company: Presbyterian Healthcare Services
Location: Albuquerque
Posted on: June 13, 2021

Job Description:

Overview

Type of Opportunity: Full Time FTE: 1.000000 Exempt: No Work Schedule: Days

Summary:Follows-up, collects, and resolves all outstanding accounts receivable. Performs a variety of duties including accounts receivable follow-up, customer service, correspondence response, and daily reconciliation of activities; Meets established guidelines to ensure timely and accurate reimbursement for all billed charges. Analyzes and Validates accuracy of all accounts with credit balances to determine whether payments and allowances posted are accurate according to contractual agreements and determines if a refund, adjustment, or appeal is required to resolve/close the account; Adheres to compliance and regulatory rules and regulations as mandated by CMS including researching and resolving outstanding or unbilled claims. Communicates information received from the Fiscal Intermediary, Carrier, and all other insurers regarding policies and procedures as they apply to claims billing and adjudication. Meets time guidelines to ensure timely and accurate reimbursement for all billed charges. As an expert in the ambulance revenue cycle field, actively participates in the training and education of peers and those outside the department.

Responsibilities

• Performs accounts receivable follow-up activities for their assigned payers/accounts using daily aged account work queues and/or A/R reports.Responsible for contacting insurance companies, patients, and employers regarding outstanding ambulance claims. Responsible for providing any information (medical records, itemized statements, etc.) requested by insurance companies to process claims. Must maintain a system to ensure timely follow-up is completed for each outstanding claim.Maintain workflow consisting of outstanding accounts assigned. Must work and document each account according to Patient Accounting Department policies and procedures. Responsible for following-up on all accounts listed in the workflow until resolved.Refer accounts, in accordance with PHS guidelines to ARC Supervisor for write-off, agency, or attorney referral. Refer difficult claims to ARC Supervisor or Manager for advice and/or assistance.Must work closely with all outside agencies contracted with the Patient Accounting Department, as well as internal PHS Departments, and assist them with account resolution for any accounts assigned to them by ARC Supervisor or Manager.Cross train and job shadow in various Ambulance Revenue Cycle Department areas to be completely familiar with all aspects of ambulance revenue cycle as they relate to ambulance account follow-up and collections.Performs accounts receivable credit balance reimbursement analysis to determine if reimbursement, allowances, and patient payments received are correct. Must make appropriate adjustments and refer any refunds to the Cash Processing team. Documents accounts in accordance with established PHS policies and procedures.Manages workflow consisting of accounts assigned, and external correspondence, relating to overpayments (or incorrect payments) made by insurance payors or patients within established timeframes.Responsible for contacting insurance companies, patients, employers, etc. to resolve any over payment issues that require their assistance.Must develop positive working relationship and work closely with all outside agencies contracted with Presbyterian, as well as all third party payers to effectively communicate and resolve overpayment, or incorrect payment, issues.Must work closely with all ARC areas and teams regarding discrepancies in charges, payments, allowances, etc. posted to accounts.Cross train and job shadow in various Ambulance Revenue Cycle Department areas to be completely familiar with all aspects of ambulance revenue cycle as they relate to account reconciliation and refunds.Responsible for daily claims interface, uploading and monitoring of daily maintenance reports to control unbilled insurance by assigned work queue. Analyzes, monitors and resolves pre-billing compliance. Reviews files daily and corrects errors on final bills.Ensures that goals and objectives are met in conformity with PHS policies and procedures and Medicare compliance rules and regulations. Stays informed of changes in billing procedures that impact processes and/or reimbursement effectiveness.Uses on-line policies and procedures to ensure accurate and consistent processing of claims. Submits adjustments, appeals and Fair Hearing documentation when applicable.

Qualifications

High School education (G.E.D.) with a minimum of two (2) years experience in admissions, medical claims processing, insurance billing, claims follow-up, or collections preferred. Six-months to one-year experience in a computerized accounts receivable system preferred. Short-term training in business office process and procedures preferred. PC experience with Microsoft Office Word and Excel. Excellent organizational, problem solving, verbal, written communication, and ability to interact with other functional areas required. Demonstrated ability towork effectively in a team environment. Must be able to prioritize and manage a high volume workload. Knowledge of ICD9/ICD10 and HCPCS. Education:Essential: * High School Diploma or GED

Competencies and skills:Nonessential: SKILL-Ability to effectively interact with customers to understand their needs and explain data ICD 9 OR 10 SKILL-Microsoft Office Organizational Skills Demonstration of high degree of independent problem solving and critical thinking skills. SKILL-Demonstrate ability to work effectively in a team environment SKILL-Demonstrated ability to communicate effectively in person and via telephone with members, employer groups, brokers, physicians, and physician office staff using strong dialogue and customer service competencies. SKILL-Written communication

Benefits

Benefits are effective day-one (for .45 FTE and above) and include:

• Competitive salaries
• Full medical, dental and vision insurance
• Flexible spending accounts (FSAs)
• Free wellness programs
• Paid time off (PTO)
• Retirement plans, including matching employer contributions
• Continuing education and career development opportunities
• Life insurance and short/long term disability programs

About Us Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.

Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans. We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come. About New Mexico New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great. Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC. New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

Keywords: Presbyterian Healthcare Services, Albuquerque , Ambulance Revenue Cycle Specialist 1, Other , Albuquerque, New Mexico