Summary: Under general supervision of the Business Office Manager. Contributes to the processing of various tasks required to achieve department goals and objectives. Adheres to all policies and procedures documented in the Connally Memorial Medical Center policy and procedure manual. Maintains effective relations and communications with all customers of the revenue cycle process.

Essential Duties and Responsibilities include the following:

• All incoming calls must be answered and distributed to the personnel responsible for the calls that day.
• Works closely with all of the areas that have a part in the revenue cycle of the hospital. Conducts measurements of the payment denial reasons, works with the appropriate staff member to obtain successful appeals and reports results to the Business Office Director.
• Analyzes and trends the root cause of Payor denials and audits.
• Takes corrective action to receive proper payment for services rendered through writing appeal letters and verbal communication with internal and external sources.
• Assists in the development of process designs to eliminate causes of denials and underpayments and/or improve the clinical information flow when processing appeals.
• Works with the Medical Records Department and/or Case Management to solve patient status issues arising after the patient has been discharged.
• Assists in fostering and cultivating action plans to eliminate reasons for payment denials.
• Provides input to Case/Quality Management department about pre-certification problems resulting from clinical information issues.
• Completeness and timeliness with attention to Payor regulations.
• Collaborates with other departments to create systems and problem solve ongoing issues that impact departmental/organizational goals and/or patient care delivery.
• Provides customer service to hospital personnel in a timely, professional manner.
• Maintains open communication using appropriate chain of command regarding issues.
• Performs related duties and projects as assigned.

Education and/or Experience

Minimum 2 years experience in hospital billing and collection related functions. Solid knowledge of Managed Care reimbursement methodologies and collections. Knowledge of hospital policies and procedures impacting patient admission and/or registration processes that impact reimbursement. Must have a clear understanding of the RAC, MIP and other Payor audits, along with post pay managed care audits. Must have proficient Excel, written communication, and organizational skills. In addition to pre/post Payor audit experience.

Other Qualifications

Knowledge of THMP and Medicare system and insurance Payor guidelines desirable. At least 2 years of hospital commercial collection experience, resulting in maximum reimbursement. Must be detail oriented with excellent communication skills. Great customer service skills a must. Computer literate, knowledge of, or ability to learn hospital soft ware is required. Evening and weekend shift as required.