Primarily responsible for effective collection on patient accounts, accounts receivable follow up, and reimbursement analysis. Coordinates activities with stakeholders.
Every Adelante employee will strive to maximize their performance and contribution to Adelante Healthcare and the community we serve every day. Employees are expected work in a manner that demonstrates a commitment to quality, patient safety, employee engagement, innovation, and the highest standards of personal integrity, professionalism and competence.
OUR CORE VALUES
ESSENTIAL SKILLS AND EXPERIENCE
- Two (2) year college degree AND greater than (3) years experience in a medical accounts receivable roles such as:
- Accounts Receivable Representative
- Patient Collections
- Working knowledge of medical, accounts receivable, collections, rejects, denials, appeals, and research billing guidelines and policies
- Demonstrated knowledge of CPT, CDT, ICD-9/ICD-10, HCPCS, and ADA
- FQHC experience strongly preferred
- Family practice, pediatrics, internal medicine and OBGYN strongly preferred
- NextGen experience preferred
- Provide excellence in customer service with ability to interact with and instruct colleagues from beginner to advance levels
- Working knowledge of current Microsoft Office applications
- Working knowledge of various reimbursement methodologies, including reimbursement reductions, fee schedule calculations and comparisons, and review of claims for correct payment
- Prioritization and multi-task skills are required
NONESSENTIAL SKILLS AND EXPERIENCE
- Demonstrated experience as an Advocate for Health Care or Human Rights
- Certification as Revenue Cycle Representative (CRCR,HFMA)
- Certification as professional coder (CPC, AAPC)
- Bachelors degree in Accounting, Finance, or other relevant field of study
- Fluency in a language in addition to English (Spanish preferred)
The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job related selection or promotional criteria.
- Review outstanding claims to determine what action needs to take place and make status calls to insurance companies
- Request claims to be reprocessed where necessary or prepare and submit corrected claims to the insurance companies for payment
- Review delinquent accounts and initiate appropriate collection action including telephone calls and correspondence to patients
- Answer patient calls relating to questions about their bills
- Update demographic and payer related information obtained from the patient
- May correct errors including misapplied payments/adjustments and applying account credits
- Prepare refund requests for management approval
- Responsible for the generation and mailing of claims
- Work payer rejects and denials
- Support and train site checkout staff
- Support management on special projects
- Maintain a high level of customer satisfaction as reflected on patient satisfaction surveys and other measurement tools
Additional Duties and Responsibilities
- Additional duties as requested or assigned
All employees are responsible for promoting and participating in interdisciplinary communication and collaboration to enhance the delivery of quality across the health care system. Employees should maintain an environment which supports and engages patients and co-workers in a caring team based model to promote wellness and improve health outcomes.
Adherence to Compliance and Code of Conduct
All employees are required to comply with Adelante Healthcares written standards, including its Compliance Program and Standards of Conduct, policies and procedures and reporting of any conduct that potentially violates Adelantes legal or compliance requirements. Such compliance will be an element considered as part of the regular performance evaluation.
PHYSICAL DEMANDS AND WORK ENVIRONMENT
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical demands: While performing the duties of this job, the employee may be required to sit for long periods of time, is required to stand, walk, use hands to handle or feel objects, tools or controls; reach with hands and arms; climb steps/stairs; balance; stoop, kneel, crouch or crawl; talk or hear; smell; manage stress as it relates to essential job functions. The employee must frequently lift and/or move up to 25 pounds without assistance, and may occasionally be required to lift or move up to 50 pounds with assistance. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
Work environment: While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time when traveling to various clinic sites. The noise level in the work environment is usually moderate. The employee may be subject to health hazards (contagious diseases, blood borne pathogens, etc.) when working in the clinic area.
In any organization or job, changes take place over time. Although an effort will be made to keep job-related information current, this is not an all-inclusive list of job responsibilities. Adelante Healthcare, Inc. reserves the right to revise or change job duties and responsibilities as the business need arises. In compliance with EEOC 29 CFR part 1630, if the essential functions of this position cannot be performed in a satisfactory manner by the employee, further accommodations shall be made if it does not constitute undue hardships upon this organization.