Responsible for overall accounts receivable performance for the DeKalb Medical Hospitalist Group. Works with Explanation of Benefits (EOBs) and follows up on denials and appeals claims as necessary. Shares trending information with department Manager and the designated DMPG Coder to communicate back to the impacted providers in a timely manner.
Assists Supervisor Patient Accounts DMPG in giving work direction to team members (charge entry, registration, follow-up).
Assists with determining appropriate production methods and work levels to meet/exceed monthly goals.
Provides ongoing information to Supervisor regarding team member performance and participates in performance discussions.
Regularly reviews the Hospitalist task log to identify and report any issue/concern to the Supervisor.
Assists Patient Account Reps with Hospitalist account resolution and provides ongoing training.
Identifies training issues and provides feedback to the Supervisor.
Daily interaction with each team member, providing assistance as needed, getting feedback on any issues/concerns they are experiencing.
Reviews billing documentation; resolves issues that would prevent accurate and prompt billing.
Generates reports to identify problems; communicates problems and recommendations to Supervisor for approval.
Attends weekly meetings to discuss Hospitalist related issues and provides feedback.
Supports and maintains corporate quality, processes, policies, practices and work instruction.
Participates in continuous quality improvement activities and teams.
Participates in supporting the organization’s vision, mission and values and adheres to DeKalb Medical Standards of Behavior.
Performs other duties as assigned to meet the goals and objectives of DeKalb Medical.
Minimum Education, Experience and Licensure Required:
Associate’s degree preferred
Six (6) or more years of job-related experience in a Centralized Business Office or Specialty related environment.
Certified Professional Coder (CPC) preferred
Certified Patient Account Representative (CPAR) preferred but not required.
Working experience with medical terminology.
Working experience with human anatomy.
Working knowledge of third-party insurance in regards to plan types: HMO, PPO, POS, and Indemnity.
Skills, Knowledge and Abilities:
Ability to read accounts and identify and correct posting errors.
Ability to resolve claim denials based on an escalated appeal process.
Strong working knowledge of standard CPT and ICD9 coding.
Knowledge of Government/Managed Care plans.
Skill and ability to communicate verbally, including public-speaking, and in writing
Skill and ability to make decisions and solve problems by identifying creative options and/or solutions
Skill and ability to effectively manage multiple tasks and priorities within a fast-paced environment
Skill and ability to anticipate, manage, and adapt to change
Knowledgeable about Medicare, Medicaid and Managed Care, competent on computerized patient information system, understands patient accounts, and has excellent customer service skills.
Skill and ability to operate independently and collaboratively as part of a team
Knowledge and skill to gather and summarize data from multiple sources and analyze using common statistical functions
Skill and ability to manage internal and external relationships
Skill and ability to lead and take initiative
Reports to: Manager Business Office DMPG