The Patient Account Follow-up Specialist is responsible for collecting and appealing outstanding claims. It is the responsibility of the position to ensure that expected reimbursement from all payers for patient care is processed timely and paid accurately, and that the maximum allowable reimbursement is garnered for the services.
Job Duties & Responsibilities:
Follow up and investigate any billing errors returned from payers.
Work with respective team members/supervisors for resolution.
Manage and maintain outstanding patient balances to ensure accurate reporting of Accounts Receivable
Meet position?s goals and objectives related to accuracy and productivity; i.e., days in Accounts Receivable, cash collections, open claim count, reimbursement metrics, etc.
Follow up on submitted claims to complete appropriate action to ensure timely receipt and appropriate reimbursement.
Work various system reports to ensure accurate classification of accounts and to ensure that all accounts have been billed and received by payers.
Suggest billing component changes as necessary for payers.
Routinely communicate with payer regarding delinquent or denied claims.
Address issues and clear barriers to payment.
Utilize on-line/telephonic resources to verify benefits and to ensure claims are processed according to the appropriate benefit levels.
Responsible for managing claim details and verifying accurate reimbursement.
Initiate account adjustments and/or appeals on payment disputes.
File appeals for denied claims and follow up as necessary through appeal resolution.
Submit refund requests as necessary.
Perform other duties as assigned.
Function with a great deal of autonomy.
Verbal and hearing ability required to interact with patients and employees. Numerical ability required to maintain records and operate a computer.
Able to plan, control and direct all aspects of employee relations. Tact required to interact effectively with employees and professional staff. Logical thinking and discretion required to make decisions in initiating and implementing policies and procedures and standards.
Must be able to read and communicate through written, verbal and auditory skills and abilities.
Physically/Mentally able to perform job duties as verified by a physical exam by a licensed physician, per post-employment physical.
Demonstrate effective communication skills.
Demonstrate good organizational skills.
Contribute in a positive, solution-focused manner
Attend outside seminars and/or educational classes to promote professional growth.
Demonstrate a positive and professional attitude toward parties outside the hospital (provider relations representatives, managed care contractors, visitors, vendors, etc.).
Comply with the hospital?s policies and procedures, including human resources, infection control, and employee health policies and programs.
Project a professional image by wearing appropriate, professional attire.
ABOUT ROGERS BEHAVIORAL HEALTH
Based in Wisconsin since 1907, Rogers Behavioral Health is a private, not-for-profit provider of behavioral health services and is nationally recognized for its specialized psychiatry and addiction services. Anchored by the main campus in Oconomowoc, WI, Rogers offers evidence-based treatment for adults, children, and adolescents with depression and other mood disorders, eating disorders, addiction, obsessive-compulsive and anxiety disorders, and Trauma (PTSD).
Rogers provides residential care and has three inpatient facilities that serve southeastern Wisconsin. Rogers also offers outpatient services throughout the state of Wisconsin as well as in California, Florida, Illinois, Minnesota, Pennsylvania, and Tennessee.
The System also includes Rogers Behavioral Health Foundation, which supports patient care, programs, and research; and Rogers InHealth, an initiative that works to eliminate the stigma of mental health challenges. For more information, visit www.rogersbh.org.Required Skills
Basic Microsoft Office, Excel, Word, OneNote, Teams , Cerner preferredRequired Experience
Knowledge of payers and self-pay reimbursements, collections, appeals, claims follow-up and third-party billing, required (HMO/PPO, Medicare, Medicaid, Commercial)
Experience with medical records or patient accounting systems, preferred.
Knowledge and understanding of state and federal insurance program to ensure compliance and accurate reimbursement, required.
Knowledge and understanding of healthcare explanation of benefits (EOBs) , UB04 and HCFA 1500 claim forms
Electronic software experience, preferably Cerner