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Form of workZymeda Provider Solutions seeks a robust, well-rounded, versatile individual with whole RCM experience to join our thriving company. You will join a growing and successful company and a team of experts trying to accomplish the same goal. This position is full-time, goal-oriented, revenue-driven, highly accurate, provides efficient service, and is individually motivated.
Essential Functions of the Job:
- Ensure accuracy and compliance with billing, coding, and follow-up requirements and identifies overpayment and lack of documentation issues.
- Ability to identify, review, analyze, interpret, and present complex data; and to use creative thinking and logic to investigate and solve problems, including making recommendations to outside departments to eliminate future problems.
- Identify and resolve issues involving reimbursement
- Post all personal, insurance and liability payments and EOBs to appropriate accounts with minimum to no errors
- Apply manual payments and electronic payments to accounts for payor types of Medicare, Medicaid, and Commercial Insurance;
- Analyze EOB information, including co-pays, deductibles, co-insurance, contractual adjustments, denials, and more to very accuracy of patient balances
- Investigate the source of unidentified payments to ensure they are applied to appropriate accounts. If necessary will contact the sender to clarify where the payment should be posted
- Send all batch reconciliation information to Team Lead or Manager
- Assist in performing check deposits and assembling logs daily; Assist in performing a comparison of downloaded files to the Direct Deposit and correct any discrepancies
- Performs various collection actions, including denial management and insurance companies by phone, correcting and resubmitting claims to third-party payers. Contacting patient for clarification of information needed to post payment and balances owed successfully.
- Thorough understanding of payers and payer contracts
- Periodic auditing and validation of clearinghouse batches being processed from EMR
- Ability to understand insurance contracts for billing and collection purposes
- Communicate regularly regarding the status of receivables and authorizations, and encounter issue trends.
- Establishes payment plans to help patients manage payment of bills.
- Rebills insurance companies or other third parties to secure payment for patients.
- Coordinate collection of outstanding monies not received during patient visits.
- Generate collection phone calls and correspondence for billing.
- Coordinate referral of bad debt accounts to collection agencies.
- Prepare, review and send patient statements per client guidelines.
- Gathers, compiles, and analyzes billing and statistical analysis.
- Ability to prioritize and handle multiple tasks and projects concurrently
QUALIFICATION REQUIREMENTS:
- 5 years of related experience and/or training; or equivalent combination of education and experience. Knowledge of the current healthcare climate, including managed care developments, HIPAA standards and governmental program regulations.
- Accurate typing/data entry at a minimum of 40 wpm.
- Knowledge of current coding practices in regard to billing and processing of Explanation of Benefits. General knowledge of how government payers reimburse. Knowledge of CMS and Medi-Cal regulatory guidelines relative to LCDs, NCD's, and claims processing.
- Ability to handle payment in accordance with detailed instructions. Analytical problem solving, uses intuition and assess own strengths to complement data by following competencies.
- Strong research, analytical, data entry and troubleshooting skills are required. Ability to use a Windows based computer system and common business software found in Microsoft Office (Excel, PowerPoint, Word, Outlook etc.) Knowledge in Lytec, Prime Suite, Office Ally and accounting and billing software are a plus. Excellent phone skills are required. Ability to multitask and manage time effectively.
EDUCATION: High School diploma required; Associate's or Bachelor's degree in Business, Finance or Accounting preferred
CERTIFICATES, LICENSES, REGISTRATIONS
Medical Coding preferred
Medical Billing preferred
About Zymeda:
We are a revenue cycle management company focused on providing physician practices with the consulting services, process improvement, operational benefits and revenue cycle capabilities enjoyed by large medical groups. As a growing company based in Southern California, our company offers clients a unique level of service complimented by access to our leadership team and industry experts.
The People:
Our team of Billing & AR specialists comprises of various backgrounds and experiences. We work together to ensure everyone has the training, resources, and knowledge to enjoy the tasks that make them and Zymeda successful. Many team members take advantage of opportunities to grow professionally because we also like to promote from within.
Team Culture:
We are committed to fostering a positive work atmosphere where hard work is mixed with fun so that our teams look forward to coming to work. We reward innovation, problem-solving, and process improvements.
Check us out at www.zymeda.com
