Medical Administrative Assistant

Job Description:

Title: Senior Payment Reviewer
Department: Patient Accounts
Hours: 8 am-4 pm, Monday - Friday
Pay: Based on Experience (compensation should be above that of Payment Reviewer ($25.88- $38.84))
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. Review the HMO/Insurance contract matrix, and EMR expected reimbursement amounts to ensure appropriate reimbursement. Maintains systems contract proration audits accounts to ensure accuracy. Responsible for the upkeep of contract matrix and proration management. Evaluate and educate the payment review team on performance and expectations. Responsible for training on contracts and staff responsibilities.

Essential Functions and Responsibilities Include the Following:
1. Understands and adheres to the client's performance standards, policies, and behaviors.
2. Assist with daily oversight of the payment review team, including staff training and guidance.
3. Assure expectation and monitors performance to ensure department goals are met.
4. Assists management with monitoring and reporting on quality assurance controls, productivity measures, and time off requests for presentation to Supervisor and Manager.
5. Responsible for ensuring all assigned tasks are planned out with direction and monitoring of all work to the team.
6. Assists management with ensuring employee compliance with hospital and Human Resources policies and procedures employee competency and education requirements are satisfied per hospital policy.
7. Attends Management/Leadership meetings as scheduled/required and communicates hospital policies, performance improvement initiatives, and all other required information to the team.
8. Is supportive of hospital initiatives and projects and functions as a positive change agent.
9. Promotes a positive and professional image as a role model, coach, mentor, and resource for staff and peers.
10. Review 3rd party remittance advice to ensure proper payment was received from the insurance carrier based on a contract arrangement.
11. Full understanding of contracts as they relate to client reimbursement.
12. Review EMR to ensure the expected reimbursement amount is received by an insurance carrier.
13. Contact insurance payor liaisons and provider representatives regarding any reimbursement discrepancies.
14. Research and initiate refunds to patients or insurance carriers as needed.
15. Sends inquiries to patients regarding inaccurate or incomplete information.
16. Completes charge adjustments and allowances entries on accounts as needed.
17. Analyze denials related to the contract(s) and collaborate with the denials team to ensure processing.
18. Assure payor plan types and policy numbers are updated accurately within the EMR.
19. Assists with telephone calls as needed.
20. Responsible for upkeep and maintenance of HIS proration.
21. Responsible for training of staff and staff performance audits.
22. Assist management in staff evaluation, performance review, and reports as assigned.
23. Upkeep of contract matrix for the facility.
24. Collaborate with senior managed care analysts for trends and updates, utilizing box when appropriate.
25. Assure any needed customer service with payors and/or patients for claim processing.
26. Performs all other related duties as assigned.
27. HBI certification required.

Requirements:

• High School Diploma 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.
  
• Previous supervisory (Team Lead or Supervisor) experience in a hospital setting is strongly preferred.
  
• Familiarity with electronic medical record system, EPIC preferred.
  
• Proficiency with Microsoft Office/Excel to include PIVOTS and vlookup, intermediate level required.
  
• Must be 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 speak, write, understand, and communicate in English.
  
• 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 needs to occasionally move about 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.