OHSU is Oregon's only public academic health center. We are a system of hospitals and clinics across Oregon and southwest Washington. We are an institution of higher learning, with schools of medicine, nursing, pharmacy, dentistry and public health - and with a network of campuses and partners throughout Oregon. We are a national research hub, with thousands of scientists developing lifesaving therapies and deeper understanding. We are a statewide economic engine and Portland's largest employer. And as a public organization, we provide services for the most vulnerable Oregonians, and outreach to improve health in communities across the state.
As the CCMC Follow-up Representative you will be responsible for billing, process adjustments, collect on accounts, and/or perform customer service duties to ensure that monies due University Hospital are secured and paid in a timely manner and the AR outstanding days of revenue are kept to a minimum. Assignment will be flexible depending on payor mix, patient flow, and workload fluctuations.
Function/Duties of PositionThird party follow-up and collection:
- Within the stratified processing environment, collect assertively and proactively money due OHSU by contacting (through telephoning, emailing, and/or accessing on-line systems) third parties (insurance carrier, various government programs, etc.)
- Provide explanation of charges and additional requested information to the third parties.
- Analyze accounts to determine coordination of benefits, refunds, and denials to insure appropriate resolution of accounts.
- Review billing to determine medical records necessary to provide complete processing of claim.
- Analyze accounts with regard to billing and payment history and uses judgment to determines appropriate follow-up action based on departmental guidelines
- Contact patient/guarantor to resolve issues (includes tracing and locating patient/guarantor by telephoning and/or sending written correspondence.)
- Analyze accounts and interpreting contracts that dictate how claims should be paid and processing adjustments for contract interpretation.
- Comply with special billing and follow-up requirements regarding adoptions, court holds, motor vehicle and personal injury accidents, and other unique or sensitive accounts
- Work reports of denied claims to trend and report these claims to the department and to our front end partners
- Work closely with admitting, care management and ambulatory services on the denied claims for resolution and feedback purposes
- Prepare the appeals for selected denials.
Billing
- Submit bills that comply with all appropriate regulations, managed care contracts to third party payors.
- Calculate the correct reimbursement of all managed care claims.
- Two years of recent (within the last 5 years) experience billing or collecting healthcare accounts in a business office; OR
- Four years of general collection, billing or customer service experience; OR
- Equivalent combination of education and experience.
- Certified Revenue Cycle Specialist (CRCS) is required within 18 months of hire.
- 1 year of recent medical collection and/or billing experience. Work experience must have occurred within five years of the date of hire.
- Recent (within one year of date of hire) Microsoft Office Suite experience in Windows environment with skill in document production using WORD, spreadsheet construction in EXCEL.
- Experience in billing Hospital claims or UB-04 claims.
- Knowledge of and experience in interpreting managed care contracts.
- Familiarity with DRG, CPT, HCPC and ICD-10 coding
- Typing 45 wpm
- Ability to use multiple system applications
- Demonstrated ability to communicate effectively verbally or in writing.
- Demonstrated ability to prioritize and accomplish multiple tasks in a fast paced environment; consistently adhering to defined due dates.
Pay Range: $23.19 - $31.37 per hour
Benefits:
- Two raises per year - One at anniversary date and one across the board annual increase
- Healthcare Options - Covered 100% for full-time employees and 88% for dependents, and $25K of term life insurance provided at no cost to the employee
- Two separate above market pension plans to choose from
- Vacation- up to 200 hours per year depending on length of service
- Sick Leave- up to 96 hours per year
- 8 paid holidays per year
- Substantial Tri-met and C-Tran discounts
- Additional Programs including: Tuition Reimbursement and Employee Assistance Program (EAP)