Payment Reviewer

Job Description:

Our client, a White Plains, NY-based medical facility, seeks a Temp to Perm Payment Reviewer. Please review this opening and let me know if you want your resume submitted.

Temp to Perm Payment Reviewer
Department/Location: Patient Accounts
Reports to: Supervisor, Patient Accounts
Pay up to $30

Position Summary

• Reviews all remittance advice to ensure appropriate reimbursement for 3rd party accounts billed. Reviews HMO/Insurance contract matrix and HIS expected reimbursement amount to ensure appropriate reimbursement.
  
• Takes necessary action to resolve account variances and ensure adherence to contract terms.
  
  Essential Functions and Responsibilities Include the Following:
  
• Understands and adheres to the client's Performance Standards, Policies, and Behaviors
  
• Reviews third-party remittance advice to ensure proper payment was received from insurance carriers based on contract arrangement
  
• Reviews HIS to ensure the expected reimbursement amount is the amount received by the insurance carrier
  
• Takes necessary action on any reimbursement discrepancies to ensure payments adhere to contract rates and terms
  
• Research and initiate refunds to patients or insurance carriers as needed
  
• Sends inquiries to patients regarding inaccurate or incomplete information
  
• Escalates issues to management and provider representatives regarding incorrect payer processing and/or contract issues
  
• Completes charge adjustments and allowances entries on accounts as needed
  
• Recodes accounts by insurance carrier and plan number and enters into the HIS for rebilling purposes
  
• Processes rejections on accounts denied by insurance carriers
  
• Assists with telephone calls as needed
  
• Contacts insurance carriers as needed for additional payment and or credit resolution
  
• Performs all other related duties as assigned
  
• HBI certification is required prior to the end of the probationary period
  

  Requirements:

  Education & Experience Requirements
  
• High School Graduate or GED required
  
• Clerical experience required
  
• Previous hospital experience preferred
  
• Ability to use basic office equipment and knowledge of CTR computer terminals a plus
  
• Medical terminology is helpful but not mandatory
  
• HBI certification is required prior to the end of the probationary period
  
  Core Competencies
  
• Ability to cooperate with others
  
• Must be able to speak, write, understand, and communicate 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 in a stationary position 50% of the time
  
• The person in this position must occasionally move about inside the office to access file cabinets, machinery, etc.
  
• The person in this position frequently communicates with insurance plans and must be able to exchange accurate information in these situations.