POSITION SUMMARY:
The System Coordinator, Patient Accounts II serves as the secondary gatekeeper
for the Nexus Health Systems Business Office. This position is responsible for
handling Central Business Office incoming telephone calls, correspondence, and
patient account documentation for accounts assigned aged 61+. Position confirms
that the patient financial folder contains the completed and appropriate billed
claims; billing account documentation supports the expected reimbursement for
timely and accurate collections per the contract. The position creates Federal
and State mandated reporting.
JOB-SPECIFIC RESPONSIBILITIES:
1. Responds to telephone calls, working with those that are routine in
nature, or routing the appropriate staff member as calls occur.
2. Confirms admission documentation from the facilities and the CBO biller;
the claim documentation is accurate compared to the assigned payer per contract
guidelines.
3. Communicates internally/externally to obtain additional patient
information to collect timely and per the contract.
4. Confirms claims were billed and received for accounts assigned.
5. Confirm patient financial folders are assembled and maintained
sequentially. Confirm claims were billed and correspondence matches to the
appropriate patient account when filing completed EOBs.
6. Requests rebill claims as payers identify no claim on file or claim denied
by providing appropriate requests to billers. Obtain complete information from
the payer to rectify and allow claims to be billed correctly and timely via
paper and/or electronic to have claims reimbursed timely.
7. For claims submitted timely and accurately that remain unpaid past the
contract requirements must be pursued for 100% of total charges.
8. Confirm claims submitted electronically have been received with no
rejections.
9. Claims rejected or not confirmed received are to be requested from the
biller immediately. Provide information to ensure the claim is submitted
correctly to the biller. Mandatory to work and collect on estimated 35 accounts
per day. Account documentation is required.
10. Document payment, adjustment, patient responsibility daily as EOBs are
received or verified electronically.
11. Submit Adjustments within 24 hours of receipt of posting payments or
receiving EOBs. The claim must be resolved within the same month the payment is
posted.
12. Document collection efforts taken on each account billed for claims aged
60+ days. All actions taken must be noted. Collections or billing confirmation
can be obtained via phone call to the payer, lockbox, or online.
13. Mandatory to work 35+ accounts from aging daily.
14. Prepares and summarizes accounts actions for accounts aged 90+ for
monthly CEO AR call.
15. Responds to correspondence within 24 hours from the date of receipt.
16. Communicates with facility personnel to coordinate patient documentation
required to appeal or rectify payments.
17. Forward denial correspondence to the appropriate staff to assist with
appeals.
18. Files all bills, appeals, communication to each patient/claim
appropriately in the patient chart.
19. Identify credit balances monthly and prepare adjustments to refund
appropriate credits before the end of each month for Federal and State-funded
agencies. (Medicare, Managed Medicare, Medicaid, Managed Medicaid, DARS).
20. Credit balances on non-Federal or State Funded claims are prepared on the
adjustment sheets and forwarded to Refund Pending, waiting for refund requests
from payers.
21. Work accounts assigned on aging twice per month. Follow-up is required
every 7-14 days, depending on how the claim was billed.
22. Pull paid accounts monthly from patient files to box and store. Confirm
the file is complete and in order before boxing if the file is reviewed during
any audit processes.
23. Identify any internal/external changes, processes, procedures, etc. that
may create reimbursement issues.
24. Assists other CBO employees as necessary.
25. Performs all other duties as assigned.
POSITION QUALIFICATIONS:
EDUCATION:
• A high school diploma is required
• One to two years college preferred.
EXPERIENCE:
• Minimum of one (1) year of experience in a hospital business office
setting, or at least one year of experience in the medical billing/collection
field.
LICENSURE/CERTIFICATION:
• None required