WellSpan Health
Certified Patient Account Representative - Chambersburg - Days
WellSpan Health, Chambersburg, Pennsylvania, United States, 17201
Billing Specialist
Full time (40 hours weekly) M-F, Flex option of 6a-2:30p, 6:30a-3p, 7a-3:30p, 7:30a-4p, 8a-4:30p, or 8:30a-5p Position Function
Under the direction of the Assistant Patient Account Manager, is responsible for the billing of Medicare, Medical Assistance, Blue Cross, Highmark Blue Shield, Tricare, commercial insurance, managed care, auto, workers compensation and other payors to the appropriate intermediary or third party payor. Receives and reviews direct pay accounts, past due bills, and follow-up documents for all direct pay accounts of a specified collection group. Contacts payors and patients to secure payments or arrange alternative settlement plans. Core Values
Demonstrates service excellence and patient and family centered care by showing respect, honesty, fairness and a positive attitude toward all customers. Maintains confidentiality. Demonstrates dependability, to include attendance and punctuality. Is accountable - takes initiative and ownership of issues. Displays a professional demeanor. Represents hospital in a positive way. Has a compassionate working relationship with patients and families. Assumes personal responsibility for 2-way communication. Communicates and listens effectively with patients, families, coworkers, other departments, physicians/providers and community. Supports coworkers, initiatives and a patient and family centered philosophy; pitches in; does own part and helps others. Works to continuously improve work environment/processes (Performance Improvement). Demonstrates a patient and family centered focus when considering/developing improvement solutions. Represents willingness/enthusiasm to create, embrace and facilitate change. Develops self and others; supports a learning environment; leads by example. Encourages patients and families to give feedback and suggestions for improvement. Develops working relationships critical to the organization including patients, families, coworkers, other departments, physicians/providers and community. Encourages others by providing recognition and support. Technical Excellence
Thinks critically; utilizes sound judgment; promptly reports potential risks. Maintains state of art knowledge of area of specialty, healthcare trends and practice, and populations served. Maintains a level of computer literacy appropriate to their role. Meets and maintains current all unit specific and organizational skills/competencies, certifications/licences, as required. Completes hospital-required reviews, e.g. HIPAA, safety, health screening, care concerns, and others as assigned. Adheres to National Patient Safety Goals. Job Specifics
Understands Payor Regulations as they apply to billing, cash payments and patient responsibilities. Adheres to regulations. Reports any activity suspected as non-compliant to the Compliance Hot Line. Also, reports to Hot Line any situation where a person of influence has directed the employee to adopt a process suspected to be non-compliant. Establishes and maintains accuracy, integrity, and completeness in all records, reports, and claims issued in conjunction with responsibilities. Prioritizes workload at the beginning of shift so that important deadlines are met. Informs Assistant Patient Account Manager of any problems which would prevent the timely completion of work. Handles all communication to patients, their agents, and Hospital agents with the highest regard for good customer service. Treats all external customers with a high degree of respect. Attends scheduled departmental in-services and staff meetings to develop communication skills, learn new forms/procedures, etc. Participates in special projects conducted by the department or other area as workload permits. Participates in disaster and other emergency drills, M-1 disaster or evacuation. Understands and follows hospital fire and safety procedures for satellite facilities, knows personal role in case of fire. Maintains a neat, clean work area. Communicates housekeeping needs as appropriate. Actively participates in the management of information either through a computerized fashion, manual or paper-based system. Split for each Sorts Biller Queue daily. Identifies proper financial classification accounts. Keys insurance changes to be made prior to final billing. Split for each Changes Collection Group, insurance information and updates statement information as appropriate, when pertinent information is received or on a daily basis. Verifies insurance coverage if applicable. Notifies Registration, Utilization Review and HIM of corrections and additions. Immediately reports to Assistant Patient Account Manager any special situations or problems affecting receipt of payment. Reviews mail daily; responds as appropriate, within five working days. Participates in cross-training efforts to facilitate staff coverage during absences and to promote teamwork. Identifies items to be scanned and appropriately scans to either the patient account or scans documentation in batches. Reviews scanned documents for accuracy for future retrieval. Keys adjustments for small balances, Charity write offs, and other charges not payable by insurance or the patient, as per established guidelines. Staff completes bank deposits and ensures accuracy between deposits and what was posted to individual patient accounts in Meditech. Reviews Bad Debt Recovery Report notifies collectors of payments, write-offs and differences in balances, daily. Responds to all correspondence from collectors daily. Receives all inquiries pertinent to insurance information from patients, collectors, etc.; researches as appropriate, paying close attention to detail. Reviews delinquent accounts and related documents; identifies additional information needs; contacts proper billing staff or other appropriate personnel to obtain pertinent information/clarification as needed. Arranges alternate payment plans based on department guidelines. Follows guidelines as outlined in policy and procedure. Answers the phone in accordance with department policy. Takes complete phone messages to include caller data and response requested. Displays proper telephone etiquette and respect for external customers at all times. Reviews self-pay surgical accounts prior to service to arrange payment. Estimates charges as requested by patients wanting to comparison shop for services. Meets department guidelines for maintaining all miscellaneous CPS WQ as required. Meets department guidelines for ensuring accurate financial and biographical information. Meets department guidelines for action items including follow up, rebilling, or adjustments. Computes hospital bill. Mails or electronically submits itemized bills to include any necessary coding needed to comply with third party payor requirements. Completes billing by five working days following final billing. Meets department guidelines for maintaining all miscellaneous biller WQ's as required. Resolves accounts due to no payment on account balances in a timely manner. Appropriately notes accounts with claim status from insurance websites or insurance customer service. Meets department guidelines for maintaining Claim Edits and Rejections WQ's as required. Makes telephone calls to insurance carriers, if needed, in order for resolve rejections in a timely manner. Meets department guidelines of Denials WQ as required. Track, trend and investigate denials with insurance companies. Send appeals when required. Make sure account is ready to drop to secondary insurance. Bills any late charges when necessary. Keys appropriate adjustments if claims have processed correctly. Properly corrects insurance when receiving denials for incorrect coverage. Rebill account. Enter or update patient data into computer. Reports to Assistant Patient Account Manager any known Payor trends that may prohibit timely billing of claims or payments. Researches cash receipts or payment transmittals for patient or insurance company refunds. References cash receipts or payment transmittals as source documentation for action taken, as per established guidelines and instructions. Researches and completes refunds as per standard procedure. Posts insurance payments to proper account and bill number. Reconciles clearing account for electronically posted remittances, daily/weekly. As assigned, completes WellSpan Financial Assistance Application and Medical Assistance applications according to current guidelines. Completes WellSpan Financial Assistance Application, bankruptcy weekly, as per established guidelines; prepares and maintains files in area of responsibility. General Requirements
The following requirements are expected of all employees: Core Values: Integrity, Compassion, Excellence, Service Annual Health Screening with Infection Control and Blood Borne Pathogens Education Safety Awareness: Hospital Fire, Safety, and Disaster Procedures Confidentiality: Maintains Employee and Patient Confidentiality. Attendance: Regular attendance is an essential function of the position Leadership Standards: Character: Attitude, Integrity, Role Modeling Job Performance: Results Orientation, Customer Focus, Decision Making, Awareness Interpersonal Skills: Communication, Relationship-building, Team Player, Celebration Innovation: Breakthrough Thinking, Knowledge-Building/Sharing, Coaching/Empowering, System Vision & Management Physical and Mental Requirements: Classified as sedentary work by the Dictionary of Occupational Titles: May exert up to 10 pounds of force occasionally and/or an insignificant amount of force frequently or constantly in order to lift, carry, push, pull or otherwise move objects. - Work involves sitting most of the time on a hard or cushioned chair, but may also involve walking throughout the hospital facility or standing for brief periods of time. - Walks through hospital facility. - Sits on a hard or cushioned chair frequently. - Lifts up to 20 pounds to and from all levels (floor, waist, shoulder, overhead) on an occasional basis. - Carries up to 15 pounds occasionally through the hospital. - Bends, twists, squats, and kneels occasionally. - Reaches up to 2 feet overhead/in front of oneself on an occasional basis. - Near-visual acuity with color perception in order to view computer screen and decipher fine print. - Manual dexterity adequate for utilizing a keyboard, calculator and embossing machine and processing paperwork. - Ability to adapt to simultaneous, multiple and varied stimuli. - Auditory acuity for hearing telephone conversation, normal voice tones when not facing the individual, alarms, call bells, overhead pages
Full time (40 hours weekly) M-F, Flex option of 6a-2:30p, 6:30a-3p, 7a-3:30p, 7:30a-4p, 8a-4:30p, or 8:30a-5p Position Function
Under the direction of the Assistant Patient Account Manager, is responsible for the billing of Medicare, Medical Assistance, Blue Cross, Highmark Blue Shield, Tricare, commercial insurance, managed care, auto, workers compensation and other payors to the appropriate intermediary or third party payor. Receives and reviews direct pay accounts, past due bills, and follow-up documents for all direct pay accounts of a specified collection group. Contacts payors and patients to secure payments or arrange alternative settlement plans. Core Values
Demonstrates service excellence and patient and family centered care by showing respect, honesty, fairness and a positive attitude toward all customers. Maintains confidentiality. Demonstrates dependability, to include attendance and punctuality. Is accountable - takes initiative and ownership of issues. Displays a professional demeanor. Represents hospital in a positive way. Has a compassionate working relationship with patients and families. Assumes personal responsibility for 2-way communication. Communicates and listens effectively with patients, families, coworkers, other departments, physicians/providers and community. Supports coworkers, initiatives and a patient and family centered philosophy; pitches in; does own part and helps others. Works to continuously improve work environment/processes (Performance Improvement). Demonstrates a patient and family centered focus when considering/developing improvement solutions. Represents willingness/enthusiasm to create, embrace and facilitate change. Develops self and others; supports a learning environment; leads by example. Encourages patients and families to give feedback and suggestions for improvement. Develops working relationships critical to the organization including patients, families, coworkers, other departments, physicians/providers and community. Encourages others by providing recognition and support. Technical Excellence
Thinks critically; utilizes sound judgment; promptly reports potential risks. Maintains state of art knowledge of area of specialty, healthcare trends and practice, and populations served. Maintains a level of computer literacy appropriate to their role. Meets and maintains current all unit specific and organizational skills/competencies, certifications/licences, as required. Completes hospital-required reviews, e.g. HIPAA, safety, health screening, care concerns, and others as assigned. Adheres to National Patient Safety Goals. Job Specifics
Understands Payor Regulations as they apply to billing, cash payments and patient responsibilities. Adheres to regulations. Reports any activity suspected as non-compliant to the Compliance Hot Line. Also, reports to Hot Line any situation where a person of influence has directed the employee to adopt a process suspected to be non-compliant. Establishes and maintains accuracy, integrity, and completeness in all records, reports, and claims issued in conjunction with responsibilities. Prioritizes workload at the beginning of shift so that important deadlines are met. Informs Assistant Patient Account Manager of any problems which would prevent the timely completion of work. Handles all communication to patients, their agents, and Hospital agents with the highest regard for good customer service. Treats all external customers with a high degree of respect. Attends scheduled departmental in-services and staff meetings to develop communication skills, learn new forms/procedures, etc. Participates in special projects conducted by the department or other area as workload permits. Participates in disaster and other emergency drills, M-1 disaster or evacuation. Understands and follows hospital fire and safety procedures for satellite facilities, knows personal role in case of fire. Maintains a neat, clean work area. Communicates housekeeping needs as appropriate. Actively participates in the management of information either through a computerized fashion, manual or paper-based system. Split for each Sorts Biller Queue daily. Identifies proper financial classification accounts. Keys insurance changes to be made prior to final billing. Split for each Changes Collection Group, insurance information and updates statement information as appropriate, when pertinent information is received or on a daily basis. Verifies insurance coverage if applicable. Notifies Registration, Utilization Review and HIM of corrections and additions. Immediately reports to Assistant Patient Account Manager any special situations or problems affecting receipt of payment. Reviews mail daily; responds as appropriate, within five working days. Participates in cross-training efforts to facilitate staff coverage during absences and to promote teamwork. Identifies items to be scanned and appropriately scans to either the patient account or scans documentation in batches. Reviews scanned documents for accuracy for future retrieval. Keys adjustments for small balances, Charity write offs, and other charges not payable by insurance or the patient, as per established guidelines. Staff completes bank deposits and ensures accuracy between deposits and what was posted to individual patient accounts in Meditech. Reviews Bad Debt Recovery Report notifies collectors of payments, write-offs and differences in balances, daily. Responds to all correspondence from collectors daily. Receives all inquiries pertinent to insurance information from patients, collectors, etc.; researches as appropriate, paying close attention to detail. Reviews delinquent accounts and related documents; identifies additional information needs; contacts proper billing staff or other appropriate personnel to obtain pertinent information/clarification as needed. Arranges alternate payment plans based on department guidelines. Follows guidelines as outlined in policy and procedure. Answers the phone in accordance with department policy. Takes complete phone messages to include caller data and response requested. Displays proper telephone etiquette and respect for external customers at all times. Reviews self-pay surgical accounts prior to service to arrange payment. Estimates charges as requested by patients wanting to comparison shop for services. Meets department guidelines for maintaining all miscellaneous CPS WQ as required. Meets department guidelines for ensuring accurate financial and biographical information. Meets department guidelines for action items including follow up, rebilling, or adjustments. Computes hospital bill. Mails or electronically submits itemized bills to include any necessary coding needed to comply with third party payor requirements. Completes billing by five working days following final billing. Meets department guidelines for maintaining all miscellaneous biller WQ's as required. Resolves accounts due to no payment on account balances in a timely manner. Appropriately notes accounts with claim status from insurance websites or insurance customer service. Meets department guidelines for maintaining Claim Edits and Rejections WQ's as required. Makes telephone calls to insurance carriers, if needed, in order for resolve rejections in a timely manner. Meets department guidelines of Denials WQ as required. Track, trend and investigate denials with insurance companies. Send appeals when required. Make sure account is ready to drop to secondary insurance. Bills any late charges when necessary. Keys appropriate adjustments if claims have processed correctly. Properly corrects insurance when receiving denials for incorrect coverage. Rebill account. Enter or update patient data into computer. Reports to Assistant Patient Account Manager any known Payor trends that may prohibit timely billing of claims or payments. Researches cash receipts or payment transmittals for patient or insurance company refunds. References cash receipts or payment transmittals as source documentation for action taken, as per established guidelines and instructions. Researches and completes refunds as per standard procedure. Posts insurance payments to proper account and bill number. Reconciles clearing account for electronically posted remittances, daily/weekly. As assigned, completes WellSpan Financial Assistance Application and Medical Assistance applications according to current guidelines. Completes WellSpan Financial Assistance Application, bankruptcy weekly, as per established guidelines; prepares and maintains files in area of responsibility. General Requirements
The following requirements are expected of all employees: Core Values: Integrity, Compassion, Excellence, Service Annual Health Screening with Infection Control and Blood Borne Pathogens Education Safety Awareness: Hospital Fire, Safety, and Disaster Procedures Confidentiality: Maintains Employee and Patient Confidentiality. Attendance: Regular attendance is an essential function of the position Leadership Standards: Character: Attitude, Integrity, Role Modeling Job Performance: Results Orientation, Customer Focus, Decision Making, Awareness Interpersonal Skills: Communication, Relationship-building, Team Player, Celebration Innovation: Breakthrough Thinking, Knowledge-Building/Sharing, Coaching/Empowering, System Vision & Management Physical and Mental Requirements: Classified as sedentary work by the Dictionary of Occupational Titles: May exert up to 10 pounds of force occasionally and/or an insignificant amount of force frequently or constantly in order to lift, carry, push, pull or otherwise move objects. - Work involves sitting most of the time on a hard or cushioned chair, but may also involve walking throughout the hospital facility or standing for brief periods of time. - Walks through hospital facility. - Sits on a hard or cushioned chair frequently. - Lifts up to 20 pounds to and from all levels (floor, waist, shoulder, overhead) on an occasional basis. - Carries up to 15 pounds occasionally through the hospital. - Bends, twists, squats, and kneels occasionally. - Reaches up to 2 feet overhead/in front of oneself on an occasional basis. - Near-visual acuity with color perception in order to view computer screen and decipher fine print. - Manual dexterity adequate for utilizing a keyboard, calculator and embossing machine and processing paperwork. - Ability to adapt to simultaneous, multiple and varied stimuli. - Auditory acuity for hearing telephone conversation, normal voice tones when not facing the individual, alarms, call bells, overhead pages