AddressOverview:
Under limited supervision this position supports the vision and mission for the University of Maryland Medical Systems, a multi-billion dollar, regional healthcare facility. Expectations include, but are not limited to: Complex insurance verification, evaluating financial responsibility of patients, updating high value accounts to a billable/collectible status, thoroughly researching and resolving claim denials, claim rejections, and delays in reimbursement, utilizing all possible means to resolve accounts which include contacting patients, insurance companies and other departments. Assists the department by organizing collection procedures and meeting performance goals while adhering to current laws and payer regulations and reducing uncompensated care.
Key Responsibilities
- Works and maintains assigned receivables through work queues, age trail balance reports (ATBs), and special projects to achieve established department goals through resolution of outstanding account balances and reduction of uncompensated care.
- Assist with high priority receivable needs, complex accounts and projects assigned by management.
- Develops and maintains financial references, including guidelines for reimbursement, state and federal regulations, payer-specific reimbursement policies, procedures.
- Works with third party insurances to obtain maximum level of cash to reduce receivable.
- Ensures correct processing of outstanding insurance claims by: interpreting insurance payer responses, requesting account level adjustments, submitting appeals and claims reconsiderations, evaluating financial responsibility of patients, resolving insurance denials and claim rejections, performing insurance verification.
- Appropriates breakdowns in processes impacting the revenue cycle to end results and intervenes to ensure account resolution.
Knowledge, Skills and Abilities
- Concern for quality and ability to identify errors and implement corrections.
- Effective verbal and written communication skills are necessary in dealing with a variety of healthcare and finance professionals including senior management staff.
- Ability to work effectively in a matrix work environment and to manage multiple deadline-driven tasks and projects.
- Minimal knowledge or demonstrated ability to learn and understand HSCRC/CMS regulations, CPT (Current Procedural Terminology), and ICD-10 coding.
- Ability to operate a personal computer is required. Proficiency with the following applications is required: MS Excel, MS Word, and PowerPoint. MS Access, SAS, & Tableau is preferred.
- Ability to handle confidential issues with integrity and discretion.
- Ability to prioritize and manage work in a stressful environment.
