Please note: The person who occupies this position will be employed by Gundersen Moundview, located in Friendship, WI. (See details below)
This position will be responsible for performing Self pay account monitoring and prior authorizations for patient services. They will be responsible for follow up with patients for self-pay accounts, also with insurance companies for authorizations. They will investigate, initiate and resolve insurance issues and appeals with all insurance companies and patients.
1.Effectively communicates and educates patients on their financial responsibilities to the organization by giving estimates on services, taking payments, setting up payment arrangements and negotiating settlements on accounts under direction of Supervisor/Manager/Director. This would include the guidelines for payments and self-pay balances, along with the insurance process and statements they will receive.
2. Works collectively with payors, patients and internal contacts to identify and rectify billing issues resulting in reimbursement and final disposition of claims. Verifies accuracy of payment for correct reimbursement.
3. Ensures all services have prior authorizations and updates patients on their preauthorization status. Coordinates peer to peer review if required by insurance.
4. Maintains knowledge of all regulations by continually enhancing education specific to federal regulations, payer communications, federal registers and contractual guidelines to ensure compliance. Is familiar with government and commercial Web Sites and can research and interpret them effectively.
5.Must be familiar with appropriate regulatory and contractual guidelines including HIPAA, to review and make corrections as appropriate.
6.Adheres to Gundersen Moundview hospital mission statement, customer service standards and all system-wide policies and procedures
7.Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization/notification, and pre-certifications for identified patients. Follows up with physician offices, patients and third-party payers to complete the pre-certification process.
8.Ensures information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third-party payer requirements/on-line eligibility systems.
9. Educates patients, staff and providers regarding referral and authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance related changes or trends.
10. Maintains files for referral and insurance information and enters referrals into the system.
11. Performs other job-related responsibilities as requested
Education and Learning:
High School Diploma or equivalency
1 year work experience, preferably working in a medical facility, insurance company or office setting.
|Specialty Billing Assistant, Friendship, WI|
Equal Opportunity Employer