Avita Health System Job - 23205113 | CareerArc
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Company: Avita Health System
Location: Galion, OH
Career Level: Associate
Industries: Healthcare, Pharmaceutical, Biotech

Description

Avita Health System currently operates three major healthcare facilities and 31 clinic locations throughout North Central Ohio. Within the last three years, the system has tripled in size branching out into ten communities throughout the region. There are over 1,800 employees and 110 employed member multispecialty group of physicians and advanced practitioners that provide these communities with optimal, high-quality healthcare. In 2015, Avita has received a national award, placing them in the top 10 percent nationally in customer service.

Avita Health System continues to grow, and with our expansion we have various open positions in our Bucyrus, Galion and Ontario locations.

We are currently accepting resumes & applications for the following position, located at our Crestline, Ohio location:
 

JOB SUMMARY  

Reviews outstanding accounts for assigned payer and takes appropriate action to resolve issues preventing or delaying payment, including appealing denials. Works closely with the Electronic Billing Coordinator to assure initial claims are submitted correctly. Responds to inquiries and requests from various sources related to hospital claims and account processing.   

DUTIES AND RESPONSIBILITIES   

  • Works electronic billing rejection work list. Corrects errors and resubmits rejected claims within 3 business days of rejection notification.  
  • Works electronic denial work list. Initiates appropriate action to reverse denial within 3 business days of receiving the denial notification.  
  • Monitors claim rejections, denials, and unpaid claim statuses for trends and issues; reports findings and recommends core issue solutions to Electronic Billing Coordinator and Hospital Billing Supervisor; and implements agreed-upon solution.  
  • Participates in the training of new Registration Representatives, contributes to the content for the Billing Bits newsletter, and actively participates in other meetings and task forces established to improve data quality and clean claim percentages.  
  • Submits secondary claims for assigned payer(s) within 2 business days of the primary insurance payment (or request from patient or co-worker when new secondary information is provided.)  
  • Reviews outstanding accounts and takes appropriate action to secure prompt and correct payment. Resolves issues preventing or delaying payment. Corrects and resubmits claims as needed.  
  • Develops a system to monitor accounts in assigned payer category that have aged 90 or more days from the admit date; ensures each account is reviewed within 20 business days of the account hitting the 90 day threshold; and takes action to resolve the account.  
  • Effectively manages assigned accounts to ensure receivable and adjustment amounts at the lowest possible level. Meets cash goals established for the department and specific payer category.  
  • Meets the A/R days and percentage of receivable over 90 days benchmarks established for the department and specific payer category.  
  • Enters concise, descriptive notes in Affinity regarding actions taken. Ensures the correct collection flow and collector are assigned to account.  
  • Responds within two (2) business days to correspondence received from assigned payer(s) and patients with insurance through assigned payer.  
  • Keeps Supervisor informed of status of assigned receivable. Brings problematic claims and proposed solution(s) to Supervisor for discussion and agreement on resolution approach.  
  • Responds promptly to written and verbal inquiries and requests from internal customers. Monitors trends and suggests process and procedural changes and/or training to improve problematic areas.  
  • Answers customer service calls that roll to personal phone extension; takes ownership of the call, following through until the question is fully answered and/or the issue resolved.   
  • Interacts with patients/families in a polite, professional, respectful, and helpful manner.   
  • Monitors trends of patient complaints and suggests process and procedural changes to improve problematic areas.  
  • Maintains a professional, working relationship with the insurance companies, government agencies and third party payers.  
  • Completes insurance refund requests in a timely manner to maintain credit balances as a percentage of assigned receivable below the established benchmark.  
  • Maintains and supports compliance standards  
  • Ensures all claims comply with federal, state, and UB04/5010 claim submission guidelines.  
  • Refers issues of concern to supervisor.  
  • Maintains current knowledge of all organizational compliance policies and procedures and performs duties accordingly.  
  • Ensures confidentiality of all patient, department, hospital, and other information and records. Secures documents and other information in order to protect patient confidentiality.  
  • Stays informed of changes in the insurance industry via newsletters, websites and educational seminars.  
  • Performs other duties as assigned.   

PROFESSIONAL REQUIREMENTS   

  • Adheres to dress code; appearance is professional, neat and clean.  
  • Completes annual education requirements.  
  • Maintains confidentiality at all times.  
  • Wears identification while on duty.  
  • Prioritizes and plans work activities and uses time effectively.  
  • Adapts to changes in work environment, manages competing demands and is able to deal with frequent change, delays or unexpected events.  
  • Identifies and resolves problems in a timely manner, gathers and analyzes information skillfully.  
  • Remains open to others' ideas and exhibits willingness to try new things.  
  • Speaks clearly and persuasively in positive or negative situations and demonstrates good presentation skills.  
  • Reports to work on time and as scheduled as well as being available to work flexible hours as necessary.  
  • Attends committee, performance improvement and continuous quality improvement meetings as appropriate.  
  • Responds to management direction and solicits feedback to improve performance.  
  • Participates in department's performance improvement and continuous quality improvement (CQI) activities.  
  • Demonstrates professionalism and courtesy when dealing with ALL people (i.e., staff, managers/supervisors, administration, patients, visitors, physicians).  
  • Represents the organization in a positive and professional manner, including in the community.  
  • Adheres to the Standards of Behavior established by the organization.  
  • Communicates the mission, vision and values of the facility.  
  • Exhibits and practices good customer service skills with both internal and external customers.   

JOB REQUIREMENTS   

  • Fully knowledgeable of, and conducts all activities in accordance with regulatory compliance requirements, including but not limited to HIPAA rules and regulations, Medicare Secondary Payer Screening requirements, medical necessity screening and ABN rules, Red Flag Rules, and billing and coding compliance rules and regulations.   
  • Knowledge and understanding of AHS managed care payer rules.  

PREFERRED   

  • Advance degree or active pursuit of advanced degree.  
  • AAHAM or HFMA certification, or active pursuit of certification.   
  • Previous hospital billing experience and demonstrated knowledge of third-party billing procedures and claim review and analysis strongly preferred.    

LANGUAGE SKILLS   

  • Ability to communicate in English, both verbally and in writing.   

OTHER SKILLS   

  • Strong computer skills, including but not limited to hospital billing software, Microsoft Word and Excel.   
  • Strong oral and written communication skills. Projects a mature, compassionate, customer-focused attitude and professional demeanor while dealing with patients, families, other external customers and vendors, coworkers, and other internal customers.   
  • Possesses and applies basic medical terminology skills necessary to read and interpret various clinical documentation, including having a basic understanding of procedure and diagnosis coding conventions.   
  • Excellent organization and time management skills, and the ability to effectively establish priorities.   
  • Self-directed and capable of working without direct supervision; but also participates as an effective team members who promotes collaboration and team spirit at all times, including offering assistance and encouragement to others.   
  • Uses an analytical approach to problem-solving activities.   
  • Possesses and applies knowledge of how to operate routine office equipment including devices such as facsimile machines, copiers, online credit authorization devices, optical scanning equipment, printers, etc.    

PHYSICAL DEMANDS   

  • For physical demands of position, including vision, hearing, repetitive motion and environment, see following description.  
  • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising client care.   

Reviewed 02/2015 


1st Shift
8a - 4:30p
M-F
80 hours per pay


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