Position Summary: Working directly with the A/R follow up lead assists with planning, organizing, coordinating and auditing daily accounts receivable follow up and auditing for Managed care & Government program accounts. Position exists to ensure that all services performed by Omni Family Health clinics are resolved in accordance with Omni Family Health standards as well as the managed care & government contracts. Perform billing, collecting, research, correspondence, independent problem solving of account errors necessary to bring the account balance to zero within established timeframes. Responsible for reconciliation of complex, multi-payment accounts as necessary through adjustments, refunds etc.
The following are essential job accountabilities:
- Manage assigned practice and/or payer within Managed care, Medicare, Medi-Cal and other government programs to reduce the A/R and maintain established standards.
- Review accounts receivable and works selected accounts in priority of importance, independently billing accounts with understanding of applicable Medicare regulations and Managed care contractual requirements. Reports status on account for appeals/redeterminations, filing deadlines, variances etc. on selected accounts. Audits recoups and repayments to ensure that payments are accurate and comply with Medicare & Managed care contracts payment methodologies.
- Prioritize work to minimize interruptions and increase efficiency in collections process. Oversee account receivable collection campaigns and provide assistance to other billing & collection staff.
- Prepare and submit weekly & monthly AR summary of activity report for all assigned practices/payers to department manager with detailed action plans and/or unresolved issues.
- Perform retrospective audits of Medicare and managed care accounts to assist in resolving outstanding balances. Recommend and transfer outstanding patient balances to Self-Pay specialist for final account resolution.
- Assists billing dept. with entering charges into EPM updates patient demographic as necessary.
- Various other work-related duties as assigned by supervisor. These duties and responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally either verbally or in writing.
- HIPAA compliance – Responsible for enforcing compliance with all HIPAA regulations and requirements. Treats all member information confidential.
- Compliance – Ensure compliance with all local, state, and federal regulations.
- QA/QI – Participate in QA/QI activities and contribute towards the overall performance improvement of the organization.
- IT – Required to learn and use the Electronic Health Record and Practice Electronic System and its components as required by the job functions and highlighted in the Policies and Procedures.
- All employees will participate in Patient Centered Home Health Model at Omni Family Health.
Qualifications, Education, and Experience
- High school diploma or GED
- Minimum of three years billing and accounts receivable experience in a physician practice environment.
- Proficiency and accuracy with multiple office tools and software.
- Accurate data entry skills with the ability to input data into computer systems, compile statistics, and generate reports.
- Ability to work under pressure.
- Ability to demonstrate effective communication skills with providers and management staff.
- Ability to draft and implement collection letters.
- Proficient with excel and other Microsoft office products.
- Knowledge payor contracts and FQHC funding requirements.
Responsible to: Collections Supervisor
Classification: Full-time, Non-exempt