📁
Administrative/Clerical
📅
2019-R0223369 Requisition #
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Job Summary

 

 

Coordinates, develops and maintains the financial screening for patients presenting for services including; all accident payors, insurance companies, employers, auto liens, indigent care programs, collection of up-front deposits/co-payments, payroll deduction, and other related financial services.  Ensures that accurate and valid orders are received for procedures.  Obtains approvals, certifications, and referrals for patients.  Processes and maintains the patient account from registration through collections and the follow-up process until account is paid or transferred to bad debt.  Will also ensure all AR transactions are balanced between accounts receivable and general ledger so all patients are daily balanced.

  

Responsibilities

 

Scheduling:

  • Schedules specific test/procedure as requested to the appropriate resource.

  • Obtains patient information including, demographics, insurance information, diagnosis/complaint/symptom, physician name.

  • Communicates to the physician/physician office staff, patient’s information that includes, date of test, pretest instructions and request of physician orders.

  • Informs department/resource, physicians, patients of appointments/reschedules or conflicts.

  • Provides Certification Nurse with insurance information for test/procedure approval prior to test date.

  • Enters all information into the Hospital Information system.

  • Tracks resource /scheduled appointments, reschedules as needed or requested and makes necessary adjustments.

  • Maintains all orders in a central location by date order.

  • Maintains all No Shows or Cancellations.

  • Provides assistance with Registration tasks as needed or requested.

 

Precertification:

  • Obtains patient information from Physician/Physician Office staff.

  • Initiates the admission of patients that includes the completion of the admission worksheet, Physician orders, medical data, admission type approval, and distributes information as needed.

  • Records, documents all information relating to the admission and provides data to area of need including, registration, area receiving patient, Physicians, CHI Memorial Hospital Georgia (CHIMHG) staff, concurrent review.

  • Enters certification into the Hospital computer system.

  • Provides patient information including approvals, certifications, referrals, denials to various service areas routinely/upon request.

  • Shares/communicates/educates service areas including, registration, Physicians office staff, all others information relating to diagnostic/procedure codes (complaints/symptoms).

 

Insurance Approvals/Certifications:

  • Conducts insurance approvals/certifications for scheduled procedure/tests.

  • Coordinates the certification process by providing various insurance companies/other carriers with patient information including, medical.

  • Records/documents all approvals, certification data and enters all information into the Hospital computer system.

  • Communicates/shares approval data to any area of need including, concurrent review, Physicians, insurance companies, patient accounts, etc.

  • Serves as a liaison to all providers, hospital service areas as needed or requested.

  • Maintains up to date information regarding insurance certification requirements relating to specific procedure/test.

  • Provides up-to-date/current listing of procedures that requires prior approval/certification to all areas of need.

  • Provides clinical information/patient medical chart to designated area receiving patient.

  • Communicates/documents/shares disposition of patient medical chart to registration and others as needed.

 

Registration:

  • Conducts the registration/admittance procedure for patients efficiently and in accordance with CHIMHG policy.

  • Collects required patient information including; demographics, financial, insurance and medical information.

  • Enters all information into the computer hospital system accurately.

  • Obtains all required signatures for admissions documentation including assignment of benefits, release information, financial responsibility, advanced directives, religious preference, Medicare/Champus information, Medicare Secondary Payor Questionnaire, and Medicare non-coverage forms.

  • Obtains copy of insurance card/third party payor group information and patient identification (front and back of insurance cards), scan into computer hospital system.

  • Verify if the patient has a medical record and if not, create a medical record on appropriate patients.

  • Prepares assembly of medical information for distribution to area of service: patient has identification armband on arm, a face sheet, order, and patient stickers.

  • Files and distributes all admission documentation to designated areas for disposition as required.

  • Ensures physician orders are maintained for all recurring outpatient tests/procedures and plain X-rays as specified on order.

  • Maintains documentation of all transactions, shares information with others as CHIMHG policy allows.

 

Financial Integrity/Other Duties:

  • Coordinates and protects the financial integrity of the department and CHIMHG.

  • Informs patient of financial responsibility for service rendered.

  • Provides patient with information regarding financial assistance and makes the appropriate referrals.

  • Verifies and confirms accident information, verifies Workers’ Compensation and other payor groups.

  • Assists/performs all work assignments within the department.

  • Alters regular assigned scheduled hours to meet departmental need.

  • Attends/participates in departmental meetings, CHIMHG forums, and serves on committees as requested.

  • Attends job related in-service/training sessions as scheduled.

  • Provides assistance with the training of new registration/admitting personnel.

 

Patient Accounts:

  • Performs billing of claims in accordance to carrier specific requirements.

  • Conducts account review ensuring accurate billing information, enters and revises information as needed prior to claim being submitted.

  • Processes claims according to carrier specific requirements.

  • Prepares adjustment bills, rebills, reprint claims and/or other source documents.

  • Performs accurate and timely billing follow-up to applicable third party carriers.

  • Processes failed claims in biller work file according to carrier specific requirements.

  • Coordinates with Concurrent Review Precert Nurse and/or Admitting Staff on pre-certification requirements.

  • Conducts follow-up activity on patient accounts.

  • Sorts and distributes departmental mail to the appropriate representatives, supervisor, or director as needed.

  • Monitors unpaid claims via insurance work files to ensure prompt resolution.

  • Serves as liaison between patient, employer and carrier in resolving claims issues.

  • Communicates with patient, employer and carrier regarding claim status.

  • Processes patient inquiry requests within 24 hours.

  • Conducts account review to assure integrity of account.

  • Maintains control of accounts to ensure that reimbursement is received and there is no loss due to errors of omission or commission.

  • Calculates and coordinates appropriate payment resolution of patient/guarantor balances.

  • Processes credit balance to resolution.

  • Conducts account payment and adjustment review to determine reason for credit balance.

  • Retrieves associated payment documents as needed.

  • Calculates applicable payments and adjustments.

  • Prepares refund worksheet or adjustment sheet to resolve credit issues.

  • Maintains patient account information in an organized manner.

  • Updates patient demographical and insurance data in patient accounting system on an as-needed basis.

  • Prepares account specific source documents in relation to the patient accounts.

  • Prepares, monitors, and reviews carrier specific logs as needed.

  • Updates patient account follow-up, schedules, financial classes and transaction history.

  • Processes and updates accounts listed in guarantor work file.

  • Creates and maintains via account notes, all correspondence, whether written or verbal, including discussions with carriers, patients, guarantors, etc.

  • Processes account reports in a timely manner.

  • Reviews/processes claim generated not-submitted report as applicable.

  • Reviews/processes carrier specific reports to completion upon receipt, i.e., Medicare 201, C&E Billing, and Pending as applicable.

  • Reviews/processes daily admission report and combines accounts as required by specific carriers.

  • Conducts follow-up on all accounts receivable aging reports.

  • Reviews and prelists accounts on the “Bad Debt Pre-list” report as applicable.

  • Reviews accounts for processing secondary collection placement.

  • Monitors inventory of accounts listing; alpha, carrier, split.

  • Receives and processes bankruptcy notices as applicable.

  • Receives and processes IFRs as applicable.

  • Processes correspondence from attorneys, insurance carriers, patients and other third parties.

  • Researches and monitors patient/insurance concerns regarding specific services.

  • Creates and maintains on-line documentation related to concerns regarding specific services.

  • Performs review of accounts listed on remittance/EOBs, ensuring integrity of account balances, payment and TPA contracted adjustments.

  • Receives and processes insurance denials.

  • Requests medical records and other source documents as instructed by patient, insurance, or other third parties.

  • Maintains batch file of all correspondence.

  • Assists with patient inquiry coverage duties as need arises.

  • Opens, sorts, and distributes mail/return mail as applicable.

  • Assists with cash posting and billing coverage duties as applicable.

  • Prepares daily productivity reports as applicable.

  • Attends and participates in hospital and departmental staff meetings as applicable.

 

 

 

Customer Service/AR Analyst:

  • Conducts the registration/admittance procedure for patients efficiently and in accordance with CHIMHG policies.

  • Pulls Bank Statement daily from Accounts Payable.

  • Pulls and prints all Remits based on Bank Statement.

  • Performs second check from mail receipts and daily deposits from any or all ancillary department.

  • Keys all Accounts Receivable transactions daily.

  • Balances all Accounts Receivable transactions daily.

  • Work closely with Accounts Payable to ensure all balances are correct.

  • Ensure all patient accounts are accurate.

  • Files all Remits in date order for retention.

  • Great Customer Service skills when speaking with any CHIMHG customer.

  • Partners with Cashier.

  • Coordinates and protects the financial integrity of the department and CHIMHG.

  • Informs patient of financial responsibility for service rendered.

  • Provides patient with information regarding financial assistance and makes the appropriate referrals.

  • Assists/performs all work assignments within the department.

  • Alters regular assigned scheduled hours to meet departmental need.

  • Attends/participates in departmental meetings, CHIMHG forums, and serves on committees as requested.

  • Attends job related in-service/training sessions as scheduled.

  • Provides assistance with any cashier challenges.

 

Requirements


High School Diploma or GED

Previous experience in a healthcare facility preferred

Computer, organizational and communication skills, general clerical skills


 

About Us


CHI Memorial is a not-for-profit, faith-based healthcare organization dedicated to the healing ministry of the Church. Founded by the Sisters of Charity of Nazareth and strengthened as part of Catholic Health Initiatives, it offers a continuum of care including preventative, primary and acute hospital care, as well as cancer and cardiac care, orthopedic and rehabilitation services. CHI Memorial is a regional referral center of choice with 3,400 associates and more than 700 affiliated physicians providing health care throughout Southeast Tennessee and North Georgia.

Equal Opportunity Employment


Consistent with our Core Values, Catholic Health Initiatives employers are EEO/AA/M/F/Vets/Disabled Employers. Qualified applications will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identification, protected veteran status, disability or any other legally protected characteristic

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