Provides medical collection services for TLRA collection units. Utilizes a strong background as a medical collection specialist to successfully resolve accounts placed with TLRA for collection.
This involves performing collection activities related to follow-up and account resolution, and includes communication to patients, clients, reimbursement vendors, and other external entities while adhering to all client, state and federal guidelines. Patient and client satisfaction is essential. Associates in the collection unites are expected to knave knowledge of the overall collection work processes for the both active AR and BD inventory.
Provides effective collection services, ensuring the successful recovery of accounts in accordance with client and state guidelines as well as TLRA's business objectives
Understands and adheres to all policies and procedures, as well as local, state and federal regulations, relevant to their area of operation.
Documents and updates patient account information in TLRA's collection software system timely and accurately to include appropriate account status.
Handles inbound patient and/or carrier calls promptly and professionally, providing assistance and resolution to account inquiries, issues and request.
Uses collection tools effectively to ensure quality recovery services and meet or exceed established goals and work standards.
Performs research and analysis of account issues and strives to resolve problems timely and accurately.
Ensure daily productivity standards are met.
Promotes positive patient relations by communicating in a manner that demonstrates respect for the human dignity of patients and/or their families.
Performs other special projects as required when assigned.
Collections -- Traditional Government Insurance
Maintains actvie knowledge of all collection requirements by payors.
Collects balance owing from third party payers in accordance with State and Federal laws governing collections practices. Ensures that colletion efforts are thorough with overall objective being to collect outstanding balances in an eithical manner.
Ensures established quality standards are met and proper documentation regarding patient accounting records.
Contacts other departments to obtain necessary information for appeals, pending informaton and any other issues that impact and/or delay claim processing.
Provides effective and timely collection services ensuring the successful recovery of accounts in accordance with client and state guidelines as well as TLRA's business objectives.
Validates claim payments to ensure claims are paid according to contract and/or payment methodology guidelines.
Correct claims in RTP status in either CCSM or DDe per Medicare guidelines.
Initiate Medicare Redetermination, Reopening, and/or Reconsideration as needed.
HS Diploma or equivalency required
Post HS education preferred
Must have minimum of 3 years' experience with Medicare/Medicaid insurance billing, collections, payment and reimbursement verification and/or refunds.
Experience with the Medicare billing process
Thorough understanding of Medicare/Medicaid guidelines and procedures for billing, collections and appeals.
Understanding and exposure to Medicare Recovery Audit Contractor
Knowledgeable in locating and referencing CMS and/or Medicare Regulations
General hospital A/R accounts knowledge is required.
PC skills in a Windows environment are required. Solid knowledge and utilization of desktop applications to include Word and Excel are essential.
College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.
Our Mission: WHY WE EXIST. To extend the healing ministry of Jesus Christ. Our Core Values: WHAT WE BELIEVE IN.DIGNITY Respect for the worth of every person, recognition and commitment to the value of diverse individuals and perspectives, and special concern for the poor and underserved. INTEGRITY Honesty, justice, and consistency in all relationships. EXCELLENCE High standards of service and performance. COMPASSION Service in a spirit of empathy, love, and concern. STEWARDSHIP Wise and just use of talents and resources in a collaborative manner.Our Vision: WHAT WE ARE STRIVING TO DO. CHRISTUS HEALTH, a Catholic health ministry, will be a leader, a partner and an advocate in the creation of innovative health and wellness solutions that improve the lives of individuals and communities so that all may experience God's healing presence and love. Our Name and Symbol:WHO WE ARE. CHRISTUS is Latin for "Christ," and proclaims publicly the core of our mission. OUR NAME choice also recognizes the heritage of our two congregational sponsors, the Sisters of Charity of the Incarnate Word in Houston and San Antonio. Jesus Christ is the Incarnate Word, the Word of God made flesh. It is, theref...ore, only fitting that it is in another form of His name that our health ministries are called together. OUR SYMBOL Reflects the healing ministry of Jesus Christ - a combination of a medical cross and a religious cross. The flowing banner on the cross is a common symbol of the risen Christ, while the royal purple signifies Christ. The flowing banner also conveys a sense of motion as we move forward into a new era of service to our communities.