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Tri-City Medical Center · 3 months ago

PAYER ANALYST REPORT & RECOVERY - NON-GOVERNMENT ACCOUNTS

Oceanside, CA

Full-time

Onsite

Mid Level

3+ years exp

Tri-City Medical Center has served San Diego County’s coastal communities for over 60 years and is one of the largest employers in North San Diego County. The Payer Analyst Report & Recovery position is responsible for ensuring accurate billing and collection of claims, resolving underpaid and denied accounts, and maintaining departmental excellence.

Emergency MedicineHealth CareHospitalRobotics

Responsibilities

Maintains a safe, clean working environment, including unit based safety and infection control requirements

Responsible for meeting collection goals established by the department leadership

Utilizes QMS to reach daily and weekly goals

Represents TCMC when claims need to be researched with insurance companies by phone, Internet to verify payment, denial, and patient or guarantor eligibility

Ensures that all insurance payments and discounts are applied and any remaining balance is transferred to patient liability, if applicable

Takes personal initiative to bring forward process/performance improvements as identified

Performs special assigned duties to meet the needs of the department

Update patient demographic and insurance information in the patient accounting system

Trends are identified and reported to the Supervisor and Manager

Attaches supporting documentation to claims. When required verify and update insurance information on the patient’s case(s), to include taking out old payer information, selecting the proper payer number, refreshing and re-triggering the claim, and changing bill dates

Properly document steps taken while working account by utilizing the notes screen, to include telephone numbers, changes made to the insurance, and contact names

Attends and contributes to departmental meetings. Distributes new and updated information. Provides input and support to overall organization

Rebill insurance claims by both paper and electronic processes

Audit accounts for missed payments, adjustments, and remark codes

Reviews, audits and collects on underpaid or denied insurance claims and stop loss accounts according to insurance carrier contract, guidelines and requirements to ensure proper reimbursement when rebilling a claim

Writes and works letters of appeals for all denied or underpaid claims. Works all assigned correspondence and reports within 48 hours of receipt

Works with appropriate functional department (Medical Records, Clinics, Business Office) focusing on payer specific CPT & ICD-9 codes for appropriate reimbursement

Review denial codes by report in the patient accounting system for accuracy and trends

Qualification

Medical billing experienceCollection techniquesMicrosoft Office SuiteAnalytical capabilitiesPatient accounting systemTyping skillsReading comprehensionVerbal communicationWritten communicationOrganizational skillsProblem-solving

Required

Three years of hospital and/or Medical Office billing and/or collection experience is required

Verbal and written communication skills as would allow for effective interaction with carriers and patients

Knowledge of and experience in basic follow-up and collection techniques

Typing skills of 35-45 wpm

Must have good written and verbal communication skills as well as analytical capabilities

Must have business office skill sets and able to work with staff to resolve patient accounting system issues

Intermediate to advanced experience with Microsoft Office Suite, specifically Word and Excel, and Microsoft Windows

Work is occasionally performed according to existing procedures and instructions but often requires analysis of problems and development of solutions. This involves determining appropriate methods and task sequences

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job

Ability to organize and service large volumes of information and data using Microsoft Excel

Reading comprehension skills as would provide for a comprehensive understanding of the various payer contracts to which the hospital is bound

Knowledge of and experience in payment and coverage practices and terminology used by contracted payers

High School diploma or GED, required