- High school diploma or GED required.
- Associates Degree in Business or Healthcare field or two years medical office experience preferred.
- Medical Terminology required or successful completion of medical terminology course within 180 days of hire.
- Two years of related work experience in customer service, healthcare or business field required.
- Intermediate computer skills required including Microsoft Office experience. Must have knowledge and ability to learn, access and utilize the relevant computer programs listed below within 180 days of hire.
- Microsoft Office
- Star Navigator
- Claims Administrator
- OTG Application Extender
- TRAC system modules
- PC Print
- Medicare team members will be required to navigate DDE/FISS.
- Commercial team members will need to navigate the websites for Priority Health, Cofinity, Tricare, Federal Work Comp, and United Healthcare.
- Blue Cross team members will need to be able to access Web-Denis and FCC.
- Medicaid team members will be required to navigate the Michigan Medicaid online CHAMPS system
Other Entry Requirements
- Above average oral and written communication skills needed. Must be warm, friendly and sensitive to the feelings and concerns of others.
- The ability to succeed in a minimally supervised work situation and utilize proven decision making skills.
- Intermediate math skills are required.
- Knowledge of third-party payer reimbursement required.
- Applicant must be able to meet productivity standards within 180 days of hire.
Under the general supervision of the Business Office Manager and Patient Financial Services leadership team.
Applicants will have daily contact and interaction with other departments within Munson Medical Center and other internal/external customers.
AGE OF PATIENTS SERVED
X No direct clinical contact with patients
SPECIFIC DUTIES * Supports the Mission, Vision and Values of Munson Healthcare
- Embraces and supports the Performance Improvement philosophy of Munson Healthcare.
- Promotes personal and patient safety.
- Has basic understanding of Relationship-Based Care (RBC) principles, meets expectations outlined in Commitment To My Co-workers, and supports RBC unit action plans.
- Uses effective customer service/interpersonal skills at all times.
- Exercises a high degree of control over confidential medical information.
- Able to establish priorities and meet deadlines with strong problem solving ability.
- Keeps current with changing billing requirements, and shares pertinent information with billing team members.
- Follows the daily priority matrix consistently on all assigned tasks.
- Completes transmission process on electronic billing system for all current claims. Prepares and mails required hard copy claims to insurance companies, patients and/or other responsible parties.
- Unpaid claims followed up on every 30 days after the initial 45/60 day-processing period.
- Review and document procedures as appropriate.
- Review rejections to ensure compliance with third party payers and take concerns to management.
- Produce credit reports quarterly as required by Medicare. Report all credit balances to the appropriate insurance payer and process according to the payer’s requirements within 30 days.
- Demonstrates understanding of Hospital reimbursement contracts. Determines if the payment received is in accordance with the third party payors required reimbursement.
- Processes coordination of benefits claims, complying with no-fault rules and regulations and all third party payers’ guidelines, in a timely manner.
- Analyzes and initiates corrective action for patient claims. This analysis includes: auditing charges, 72/24 hour requirements, payments and contractual agreements. Must be able to resolve payment questions with insurance companies.
- Verifies insurance benefits on problem accounts and assists patients resolve MSP/COB issues.
- Reviews records in Power Chart to confirm services as separate and distinct when multiple charges have been added to an account.
- Apply a working knowledge of 3M CCI edits.
- Uses Power Chart to collect and print records to send with all hard copy Auto Accident and Workers’ Comp claims.
- May provide billing services for multiple facilities.
- Reports to financial class billing coordinator and should support team structure with emphasis on commitment to my co-worker.
- Performs other duties and responsibilities as assigned.