Patient Accounts Coordinator - Plastic and Oral Surgery(Waltham/Boston
Boston Children's Hospital
August 25, 2018
The Patient Accounts Coordinator will be responsible for:
Displaying a good understanding of authorizations and referrals based on payer requirements.
Demonstrating the ability to determine based on payer and service, when an authorization and/or referral is required.
Understanding the process required to obtain the authorization and/or referral.
Demonstrating a good understanding of the billing policies, procedures and requirements of all third party payers as well as the availability of financial aid, with regard to inpatient, outpatient and/or observation services.
Displaying a good familiarity with the billing instructions, policies, procedures and regulations, and performs patient accounting functions in accordance with these guidelines.
Preparing and submitting final, interim, and rebilled account(s) and/or claim(s) to third party payer per payer specifications.
Submitting claims to insurance carriers via mail or electronic means as required.
Reconciling the number of claims submitted and correcting any discrepancies before re‑transmission.
Researching and preparing simple payer appeals in response to denials from third party payers.
Ensuring that all required documentation is attached and submitting appeal to the payer appropriately and timely. Follows appeal through to resolution.
Communicating effectively with multiple internal and external sources in order to elicit information pertinent to the resolution or adjudication of claim(s) via verbal and/or written correspondence.
Utilizing all other investigative techniques or resources available such as manuals, regulations, contracts, etc.
Informing department supervisor or manager of internal or external matter affecting timely payments.
Contributing to problem solving efforts to resolve receivable issues through feedback, information and research.
Conducting periodic receivable maintenance to ensure that open accounts are submitted appropriately under billing deadlines.
Reviewing account(s) and/or claim(s) for accuracy of data and compliance with third party and/or presiding regulatory guidelines.
Performing activities related to the collection of payments and the resolution of accounts in accordance with Patient Account Guidelines and other regulatory requirements.
Ensuring timely resolution of claim payment through assertive follow-up efforts in accordance with the Situation Response Guidelines.
Completing follow-up to any daily as well as ad-hoc patient accounting report(s) assigned. Ensuring that the report(s) are completed accurately and timely.
Posting rejections from remittance advice, payer correspondence, scrubbers and claims clearing houses(s).
Completing all follow-up work with regard to rejections within one week of posting.
Requesting account adjustments in response to rate changes negotiated by contractual agreements with third party payers. Performing routine file maintenance as needed.
Maintaining an average QC score of 2.8 and completes an average of 95% of accounts assigned weekly.
To qualify, you must have:
A high school level of educational development and 3 to 4 years' experience.
2 to 3 years of experience preferred.
The analytical skills and judgment to interpret data and take appropriate action in circumstances and situations that vary.
The ability to communicate effectively both orally and in writing and provide empathy in difficult interpersonal situations.
**Medical, Dental and Insurance background needed**
BCH offers a flexible schedule, affordable health, vision and dental insurance, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition Reimbursement and discounted rates on T-passes.
Boston Children's Hospital is an Equal Opportunity / Affirmative Action Employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status or disability.
Internal Number: 2736136
About Boston Children's Hospital
Boston Children's Hospital is a 395-bed comprehensive center for pediatric health care. As one of the largest pediatric medical centers in the United States, Children's offers a complete range of health care services for children from birth through 21 years of age.