Medical Administrative Assistant

Job Description:

Title: Payment Reviewer
Department: Patient Accounts
Hours: 8:30 am-4:30 pm, Monday - Friday
Pay Range: $25.88-$38.84 per hour.
100% On-site
Interview process: 1st interview virtual, 2nd interview in-person.
Candidates must have experience using PivotTable and VLOOKUP in Excel.

Position Summary
Review all remittance advice to ensure appropriate reimbursement for 3rd party accounts billed. Reviews HMO/Insurance contract matrix and EMR for expected reimbursement amounts, thus ensuring appropriate reimbursement. Communicate trends to leadership and knowledge of the insurance contract matrix. Takes necessary action to resolve account variances and ensure adherence to contract terms.

Essential Functions and Responsibilities Include the Following:
1. Understands and adheres to client performance standards, policies, and behaviors.
2. Review third-party remittance advice to ensure proper payment was received from the insurance carrier based on contract arrangement.
3. Keen understanding of contracts as they relate to reimbursement.
4. Review EMR to ensure the expected reimbursement amount is the amount received by an insurance carrier.
5. Takes necessary action on any reimbursement discrepancies to ensure payments adhere to contract rates and terms.
6. Research and initiate refunds to patients or insurance carriers as needed.
7. Sends inquiries to patients regarding inaccurate or incomplete information.
8. Escalates issues to management and provider representatives regarding incorrect payer processing and/or contract issues.
9. Completes charge adjustments and allowances entries on accounts as needed.
10. Assure payor plan types and policy numbers are updated accurately within the EMR.
11. Analyze and reprocess rejections on accounts denied by insurance carriers for appropriate payment.
12. Assure any needed customer service with payors and/or patients for claim processing.
13. Contact insurance carriers for additional payment and credit resolution.
14. Performs all other related duties as assigned.
15. Responsible for ensuring productivity measures are being met daily.
16. Performs all other related duties as assigned.
17. HBI certification required.

Requirements:

• High School Graduate or GED required.
  
• 2-5 years previous patient accounting experience (hospital) preferred.
  
• Knowledge of hospital and insurance contracts is strongly preferred.
  
• Knowledge of medical terminology required.
  
• Familiarity with electronic medical record system, EPIC preferred.
  
• Proficiency with Microsoft Office/Excel to include PIVOTS and vlookup, intermediate level required.
  
• Must detail detail-oriented, able to problem solve, multi-task, and perform various duties on demand.
  
• Certified Patient Financial Services Specialist (CPFSS) certificate required.
  
  Core Competencies
  
• Ability to cooperate with others.
  
• Must be able to speak, write, understand, and communicate the English language. Effectively communicate with internal and external customers.
  
• Integrity to handle the confidential aspects of work.
  
• Retains composure under stress.
  
  Physical/Mental Demands/Requirements & Work Environment
  
• May be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may be exposed to are listed in the hospital's SDS (Safety Data Sheet) database and may be accessed through the hospital's Intranet site (Employee Tools/SDS Access). A copy of the SDS database can also be found at the hospital switchboard, saved on a disc.
  
• Must be able to remain stationary 50% of the time.
  
• The person in this position must occasionally move inside the office to access file cabinets, office machinery, etc.
  
• The person in this position frequently communicates with insurance plans and must be able to exchange accurate information in these situations.