Alameda Health Sytem
Patient Financial Services Collection/Refund Specialist
Alameda Health Sytem, San Leandro, California, United States, 94579
Patient Financial Services Collection/Refund Specialist Internal OnlyAvailable to current Alameda Health System employees only
San Leandro, CA
Finance
Patient Financial Svcs - Pro
Services As Needed / Per Diem - Day
Req #: 40233-29666
FTE: 0.01
Posted: September 30, 2024
Summary
SUMMARY: The PFS Collection/Refund Specialist is responsible for all aspects of reviewing payer contracts, claims, and performing third-party refund activity for Professional Fee services.
DUTIES & ESSENTIAL JOB FUNCTIONS:
NOTE: The following are the duties performed by employees in this classification; however, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.
Performs refund and credit analysis, audit, and reimbursement functions for all patient credit balance accounts.
Responsible for the review, preparation, and submission of the Credit Balances Quarterly Report.
Responsible for follow-up on applicable credit balance accounts.
Responds to patient insurance phone calls regarding account balances and refunds.
Handles correspondence received from payers requesting refunds.
Reports on root causes of credit balances to management.
Interacts with all campuses to resolve accounts.
Responsible for all aspects of Professional Fee follow-up and collections on insurance balances, including making telephone calls and accessing payer websites. Identifies issues or trends and provides suggestions for resolution. Accurately and thoroughly documents the pertinent collection activity performed. Reviews account information and necessary system applications to determine the next appropriate work activity. Verifies claims adjudication utilizing appropriate resources and applications. Initiates telephone or letter contact to patients to obtain additional information as needed. Performs appropriate follow-up functions, including manual re-submissions as well as electronic attachments to payers. Manages and maintains desk inventory, completes reports, and resolves high priority and aged inventory.
Responds timely to emails and telephone messages as appropriate. Communicates issues to management, including payer, system, or escalated account issues.
Maintains information or operational records; screens reports for completeness and mathematical accuracy; lists, abstracts, or summarizes data; compiles routine reports from a variety of sources.
May, as a secondary responsibility, interpret abstracts, orders, notes, invoices, permits, licenses, etc.; computes and receives fees when the amount is not in question or is readily obtainable from fixed schedules; posts data; and prepares reports in accordance with pre-determined forms and procedures.
Prepares documents for collection of revenues from third-party payer programs; checks and verifies charge rates for services; reconciles account balances and verifies payments.
Reviews billing documents to assure program compliance for Medicare, Medi-Cal, Managed Care, Mental Health, and insurance payer programs; assures that all appropriate medical documentation is included in the billing package.
Assures that all appropriate medical documentation is submitted timely.
Other duties as assigned.
MINIMUM QUALIFICATIONS:
Any combination of education and experience that would likely provide the required knowledge, skills, and abilities, as well as possession of any required licenses or certifications, is qualifying.
Required Education: High school diploma or equivalent education.
Minimum Experience: One year of experience in a Revenue Cycle area within the Alameda Health System; OR the equivalent of two years’ experience performing medical billing/collections or medical accounts receivable functions in a healthcare insurance-related environment.
#J-18808-Ljbffr
San Leandro, CA
Finance
Patient Financial Svcs - Pro
Services As Needed / Per Diem - Day
Req #: 40233-29666
FTE: 0.01
Posted: September 30, 2024
Summary
SUMMARY: The PFS Collection/Refund Specialist is responsible for all aspects of reviewing payer contracts, claims, and performing third-party refund activity for Professional Fee services.
DUTIES & ESSENTIAL JOB FUNCTIONS:
NOTE: The following are the duties performed by employees in this classification; however, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.
Performs refund and credit analysis, audit, and reimbursement functions for all patient credit balance accounts.
Responsible for the review, preparation, and submission of the Credit Balances Quarterly Report.
Responsible for follow-up on applicable credit balance accounts.
Responds to patient insurance phone calls regarding account balances and refunds.
Handles correspondence received from payers requesting refunds.
Reports on root causes of credit balances to management.
Interacts with all campuses to resolve accounts.
Responsible for all aspects of Professional Fee follow-up and collections on insurance balances, including making telephone calls and accessing payer websites. Identifies issues or trends and provides suggestions for resolution. Accurately and thoroughly documents the pertinent collection activity performed. Reviews account information and necessary system applications to determine the next appropriate work activity. Verifies claims adjudication utilizing appropriate resources and applications. Initiates telephone or letter contact to patients to obtain additional information as needed. Performs appropriate follow-up functions, including manual re-submissions as well as electronic attachments to payers. Manages and maintains desk inventory, completes reports, and resolves high priority and aged inventory.
Responds timely to emails and telephone messages as appropriate. Communicates issues to management, including payer, system, or escalated account issues.
Maintains information or operational records; screens reports for completeness and mathematical accuracy; lists, abstracts, or summarizes data; compiles routine reports from a variety of sources.
May, as a secondary responsibility, interpret abstracts, orders, notes, invoices, permits, licenses, etc.; computes and receives fees when the amount is not in question or is readily obtainable from fixed schedules; posts data; and prepares reports in accordance with pre-determined forms and procedures.
Prepares documents for collection of revenues from third-party payer programs; checks and verifies charge rates for services; reconciles account balances and verifies payments.
Reviews billing documents to assure program compliance for Medicare, Medi-Cal, Managed Care, Mental Health, and insurance payer programs; assures that all appropriate medical documentation is included in the billing package.
Assures that all appropriate medical documentation is submitted timely.
Other duties as assigned.
MINIMUM QUALIFICATIONS:
Any combination of education and experience that would likely provide the required knowledge, skills, and abilities, as well as possession of any required licenses or certifications, is qualifying.
Required Education: High school diploma or equivalent education.
Minimum Experience: One year of experience in a Revenue Cycle area within the Alameda Health System; OR the equivalent of two years’ experience performing medical billing/collections or medical accounts receivable functions in a healthcare insurance-related environment.
#J-18808-Ljbffr