patient financial services specialist

Community Health of South Florida

<p><b>POSITION PURPOSE:</b><br>
<br>
The purpose of the Patient Financial Services Specialist is to ensure that the Billing and Encounter Forms are processed correctly. Coordination of work from the patient care areas, maintaining the work flow of documents to and from Data Processing.<br>
<br>
<b>POSITION REQUIREMENTS / QUALIFICATIONS:</b><br>
<br>
<b>Education/Experience</b>:
<br>
A minimum of High School Diploma or GED Equivalent. ICD 9 Coding experience preferred. Experience with Patient Services. Must have knowledge of Medicaid / Medicare Insurance, collection and setup.<br>
<br>
<b>Licensure / Certification:</b>
<br>
Maintain current CPR certification from the American Heart Association.<br>
<br>
<b>Skills / Ability</b>:
<br>
Ability to work as a team member. Must have clerical skills, ability to type 20 - 30 wpm and have interviewing skills. Must have knowledge of math, operation of calculator; telephone etiquette, human relation skills and organizational skills. Must be computer literate. Ability to demonstrate effective oral and written communication skills.<br>
<br>
<b>POSITION RESPONSIBILITIES (THIS IS A NON-EXEMPT POSITION)</b><br>
<br>
Register new client on Intergy as per guidelines issued by Community Health of So. Florida.<br>
<br>
Researches files for previous enrollment in CHI computer system before creating a new medical record number.<br>
<br>
Re-new or update existing clients profiles as per guidelines issued by Community Health of South Florida.<br>
<br>
Performs financial screening on active clients who have requested services from Community Health of South Florida, Inc.<br>
<br>
Attempt collection o Completes assigned task in a timely manner.f past due debts as clients request services from CHI.<br>
<br>
Check-in clients for needed medical services.<br>
<br>
Check-out clients upon receiving medical services.<br>
<br>
Process of patient payments.<br>
<br>
Review and balance out daily batches.<br>
<br>
Submit daily journal to assigned supervisor.<br>
<br>
Submit cash and copies of daily batches to the Accounting Department for deposit.<br>
<br>
Complete statistical data and submit daily.<br>
<br>
Reviews Quality Care Guidelines/Patient Reminder print-out to identify overdue items e.g. Advance Directives, Learning Needs Assessment, Depression Screening, etc.<br>
<br>
Identifies patients who have not executed an Advance Directive and provide them with the Advance Directive form to read.<br>
<br>
Identifies patients who need a Learning Needs Assessment and gives them the form to complete.<br>
<br>
Identifies patients due for Depression Screening and provide them with a PHQ-9 form in the appropriate language to complete.<br>
<br>
Gives all new patients a New Patient History form to complete before Nursing Staff calls the patient.<br>
<br>
Attaches a completed new patient lab request form to the encounter form of every new patient.<br>
<br>
Consistently informs patients that their Provider wants them to read or complete the appropriate forms or education material while waiting to see the Provider.<br>
<br>
Verifies Medicare, Medicaid and all other insurance carriers.<br>
<br>
Performs daily balance closing and ensures that all procedures and payments are posted accurately.<br>
<br>
Performs cashier duties, collect patient funds for services and enters data into computer for payment received.<br>
<br>
Train new employees on all functions of Patient Services (i.e. registration, cashiering, posting of B&amp;E&rsquo;s and Payments).<br>
<br>
Use appropriate and correct telephone etiquette at all times.<br>
<br>
Participates in Continuing Educational In-services and Performance Improvement Activities.<br>
<br>
Reports to work on time and ready to work with minimal absenteeism.<br>
<br>
Completes &amp; Post all B&amp;E (billing and encounter) forms within the same of service.<br>
<br>
Adheres to the Confidentiality Policies and Procedures / HIPAA Regulations.<br>
<br>
Performs other duties as assigned, including variable shifts if needed.</p>

PATIENT FINANCIAL SERVICES SPECIALIST

Presbyterian Healthcare Services

<div><p><b>Location Address:</b></p>
9521 San Mateo NE Albuquerque, NM 87113-2237
<p></p><p><b>
Compensation Pay Range:</b></p>
Minimum Offer $15.60 Maximum Offer $22.12 Now Hiring: Patient Access Account Specialist I-ABQ<p></p><p><b>
Summary:</b></p><p></p>
Under the direction of the Patient Access Supervisor, the Patient Access Account Specialist I provides basic functions to financial clear patient accounts for government and commercial accounts prior to the date of service. Performs basic financial clearance functions, including insurance verification, authorization, collection and documentation of patient demographics, benefit analysis, and pre-service collections. The Patient Access Account Specialist I will ensure follow up on authorizations for scheduled and Urgent/Emergent procedures and admissions until date of service or discharge for admissions. The Patient Access Account Specialist I must possess a basic knowledge of Medicare (CMS) guidelines, as well as other Compliance Regulatory guidelines applicable to Patient Access to include HIPAA, EMTALA, and CMS guidelines of MSPQ. The Patient Access Account Specialist (PAAS I) monitors work queues for financial clearance and missing authorizations ensuring a payment source is identified and secured and there is a clean claim for billing. The Patient Access Account Specialist I acts as resource to all employees within Patient Access. The Patient Access Account Specialist I is responsible for providing the highest level of customer service to patients, ancillary departments and payers when financially clearing accounts. The PAAS I will work with ancillary departments to ensure the procedures scheduled and authorized meet payer requirements. The Patient Access Account Specialist I provides coverage to other areas and hospitals as needed to minimize overtime and guarantee the patients receive services as needed without registration delays. Type of Opportunity: Full time Job Exempt: No Job is based: Reverend Hugh Cooper Administrative Center Work Shift: Days (United States of America)
<p></p><p><b>
Responsibilities:</b></p><p></p>
Customer Service and Caring Practices: *Achieve exceptional patient experience for patients and patient families by using CARES, AIDET and EPE tools. *Addresses and attempts to appropriately resolve complaints in the moment by using key words at key times and de-escalation processes. *Ability to manage conflict and appropriately request the help of a supervisor when needed. *Implement PROMISE and CARES behaviors in every encounter. *Educates patients for whom they speak regarding insurance benefits and liabilities. *Ensures accounts are financially cleared prior to date of service to alleviate patient concerns over hospital financial matters Encounter Components: *Performs the patient registration process. Manage the accurate collection of patient data which includes but is not limited to; *Obtain/confirm and enter demographic and other financial and clinical information necessary for final clearance of scheduled accounts. *Review Urgent/Emergent admission accounts for notification, financial clearance and authorization pre-discharge. *Obtain missing insurance information, to include policy number, group number, date of birth, and insurance phone number if not already identified in account. *Verify insurance for eligibility and benefits using online electronic verification system or by contacting payer directly. *Review and process work queues related to Patient Access pre-visit or urgent/emergent admissions, per department guidelines. *Review of accounts falling within the work queues to ensure the insurance information contains accurate policy ID#s, Group Name and Numbers, Subscriber information, Authorization numbers, as well as correct payer and Coordination of benefits prior to date of service. *Accurately document actions taken in the system of record to drive effective follow-up and ensure an accurate audit trail. *Maintain ongoing knowledge of authorization requirements and payer guidelines. Maintain a proficient knowledge of Medicare (CMS) guidelines as it relates to admissions and outpatient services. Ensuring compliance with admissions forms, benefit entitlement verification, and billing requirements *Ensure accurate completion of MSPQ prior to date of service. *Daily focus on attaining productivity standards; recommend new approaches for enhancing performance and productivity when appropriate. *Monitor and track Data Quality program to ensure errors are corrected prior to final bill and correct accounts as necessary. *Maintain appropriate records, files, and timely and accurate documentation in the system of record. *Work with ancillary departments to ensure coding, diagnosis and facility are authorization are in alignment. *Work with payers to ensure authorization is in place; initiating the auth when appropriate. *Coordinate efforts with Financial Advocates to secure payer source current and future visits. *Monitor work queues to identify late add-on accounts and complete financial clearance procedures prior to services to avoid unauthorized procedures from being performed. *Work with physician offices to resolve discrepancies in authorizations and scheduled procedures. Financial Accountabilities: *Collects identified patient financial obligation amounts including residual balance if applicable. Collect liability from patient prior to visit or make arrangements for payment at time of service. *Ensure a payer source has been identified prior to services being rendered. *Ensure authorization for correct procedure (CPT), facility, and date of service is obtained. Patient Relations *Contact patients pre-visit to complete any information missing from the account to ensure accuracy prior to visit. *Transparency with patients through communication of patient liabilities and authorization issue in a timely manner, allowing patients ability to make informed decisions. *Educate patients and answer questions from patients on benefits, liabilities and financial options. *Provide patient with way-finding for appointment at time of pre-registration. *Perform AIDET when speaking to patient to alleviate anxiety and confusion. Quality Improvement: *Perform assigned patient care responsibilities, which may include but not limited to: *Cooperate fully in all risk management activities and investigations. *Report promptly any suspected or potential violations to laws, regulations, procedures, policies, and practices, and cooperate in related investigation. *Conduct all transactions in compliance with all company policies, procedures, standards, and practices. *Demonstrate knowledge of all applicable compliance and legal requirements of the job based on the scope of practice of the position. C.A.R.E.S Behaviors: *Demonstrates CARES behaviors of Collaborate, be Accountable, Respect, Engage and Serve to all whom you encounter. *Other duties as assigned<p></p><p><b>
Qualifications:</b></p><p></p>
*High school diploma, continued education preferred *External and Internal Non-Patient Access Candidates: Pass Patient Academy with passing score of 85% or higher *Previous completion and passing of Patient Access Advocate II and III Advancement test. *A minimum of 2 years of work experiences in healthcare setting within Patient Access and/or billing plus strong customer service background. *Strong knowledge and understanding of insurance and financial processing of accounts. *Proficient in EPIC ADT system *Specialty Certifications: CHAA, CHAM or other industry equivalent certification preferred *Pass annual competency exam for all areas of responsibility. *Requires general knowledge of the customer encounter process which may include registration, contract requirements, and coordination of benefits. *Knowledge in Microsoft Office Products. *Demonstrated strong keyboarding skills, ensuring efficient data entry and documentation. *Pass EPIC proficiency test required with a 85% score at completion of the Epic Training class. UPDATED 7/29/25<p></p><p>
All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.</p><p><b><br>
Wellness</b><br>
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.</p><p><b><br>
Why work at Presbyterian?</b><br>
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.</p><p><b><br>
About Presbyterian Healthcare Services</b><br>
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.</p><p></p><p>
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.</p><p></p><p><i>
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.</i></p><p></p><h1 class="jobSectionHeader"><b>
We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services</b></h1></div><p></p>

Patient Access Account Specialist I-ABQ

HARBIN CLINIC

<div></div><div><div><div><div><div><div><div><div><p>NC, United States<br>
Job ID: R166026
<br>
Shift: Various
<br>
Job Type: Regular
</p></div><div><div><div><div>Share: mail</div></div></div></div><div></div><div><br>
</div></div><p></p><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><p><b>Department:</b></p></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div>
13281 Enterprise Revenue Cycle - Rev Cycle Strategic Support Team: Southeast<p></p><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><p><b>
Status:</b>
</p></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div>Full time<p></p><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><p><b>
Benefits Eligible:</b></p></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div>
Yes<p></p><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><p><b>
Hou</b><b>rs Per Week:</b></p></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div>
40<p></p><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><p><b>
Schedule Details/Additional Information:</b></p></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div>
Variable<p></p><p><b>
Pay Range</b></p>
$21.85 - $32.80<p></p><p><b>
Job Summary</b></p>
Patient Accounts Specialist (PAS) works under the immediate supervision of supervisors/managers in Patient Financial Services (PFS). PAS positions perform complex tasks requiring critical thinking skills and experience-based (specialist) knowledge in PFS. Reviews difficult work queues, large dollar accounts, aged accounts and any special projects assigned by leadership. Creates reports/spreadsheets for identification of problem areas and utilizes critical thinking skills to determine appropriate actions to resolve problem. Must demonstrate thorough knowledge and understanding of patient billing, billing transmission, government regulatory/ compliance requirements, and electronic billing systems.<br>
<p><br>
<br>
<b>Essential Functions</b></p><br>
<ul><li>Prepares reports of denials, credit balances, payer opportunities.</li>
<li>Analyzes rejection reports and errors made by system and teammates. Requests system changes, reports error rates by teammate and collaborates with training to ensure improvement is achieved and sustained.</li>
<li>Prepares Medicare/Medicaid quarterly credit balance reports. Approve refunds as defined in departmental threshold guidelines.</li>
<li>Assists Supervisor/ Manager with quality checks for all payers and departments.</li>
<li>Performs quality assurance tasks as needed to validate workflow builds, claim edit actions, automatic actions in Epic, process improvements, etc.</li>
<li>Analyzes denial reasons provided by payers. Collaborates with management to identify, trend and address root causes of denials.</li>
<li>Researches and analyzes payer trends and works on special projects involving aged, high dollar or complex account issues.</li>
<li>Trains new teammates as needed.
</li></ul><p></p><b>Physical Requirements</b><br>
<p></p>Requires sitting for long periods of time. Requires bending and may need to lift-up to 10 pounds occasionally.<br>
<p><br>
<br>
<b>Education, Experience and Certifications</b></p><br>
High school diploma or GED required. Two-years' experience in related financial services or healthcare business office required. College (bachelor's or associate) degree preferred. Requires the ability to communicate effectively in verbal and written formats. Proficiency in Word, Excel and Outlook preferred. Prior healthcare computer system and specifically Epic billing experience preferred.<p></p><p><b>
Our </b><b>Commitment to You:</b></p><p></p><p>
Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more &ndash; so you can live fully at and away from work, including:</p><p></p><p><b>
Compensation</b></p><ul><li>
Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training</li><li>
Premium pay such as shift, on call, and more based on a teammate's job</li><li>
Incentive pay for select positions</li><li>
Opportunity for annual increases based on performance</li></ul><p></p><p><b>
Benefits and more</b></p><ul><li>
Paid Time Off programs</li><li>
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability</li><li>
Flexible Spending Accounts for eligible health care and dependent care expenses</li><li>
Family benefits such as adoption assistance and paid parental leave</li><li>
Defined contribution retirement plans with employer match and other financial wellness programs</li><li>
Educational Assistance Program</li></ul><p></p><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><p><b>
About Advocate Health</b></p><p></p><p>
Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation&rsquo;s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.</p></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div><p>
</p>Patient Accounts Specialist</div></div></div></div></div></div></div><div></div>

Patient Accounts Specialist

Avera Health

<div><div><div><div><div><div><div><div><p><b>Location:
</b></p></div></div></div></div></div></div></div>Avera Marshall Hospital
<p></p><p><b>Worker Type:
</b></p>Regular
<p></p><p><b>Work Shift:
</b></p>Day Shift (United States of America)
<p></p><p><b>Pay Range:
</b></p><p><i>The pay range for this position is listed below. Actual pay rate dependent upon experience.
</i></p>$19.50 - $25.50
<p></p><p><b>Position Highlights
</b></p><p>Monday - Friday, 8:00 AM - 4:30 PM<br>
</p><p></p><p><br>
<b>You Belong at Avera
</b></p><p></p><p><b>Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.<br>
</b></p><br>
<p></p><b>A Brief Overview
</b><br>
<br>
Responsible for ensuring insurance eligibility, benefit verification, and the authorization processes are complete in the time allowed by the insurance companies to prevent denials or penalties. Specialists are responsible for documenting accurate insurance information and authorization details to optimize reimbursement from both the payer and patient. The Specialist must maintain strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization. Specialists must also be able to understand and interpret patient liability and benefits for all payer types including copays, co-insurance, and out-of-pocket responsibilities in order to provide patients and families with information on their financial responsibility. The Specialist will calculate and communicate to the patient a financial responsibility estimation, provide charity applications and/or direct the patient to the business office for payment and assistance options. The Specialists will collect patient liability prior to service and attempt to collect prior balances. The Specialist collaborates with various other departments to ensure proper reimbursement on accounts. The Specialists are to conduct all transactions appropriately and consistently, and complete government regulatory forms accurately with the patient or patient's representative. Specialists must maintain compliance with government regulations (i.e. EMTALA and HIPAA) as it pertains to the insurance process.
<br>
<br>
<b>What you will do<br>
</b><br>
<br>
<ul><li>Process eligibility and secure full benefit coverage information (including COBRA when applicable) with insurance companies and employers, confirm all demographic information is correct, and ensure coordination of benefit (COB) and insurance plan codes are accurate. Specialists must verify insurance coverage immediately for inpatient and outpatient accounts that are same day and next day add-ons.
</li><li>Identify all payment sources for accurate primary and secondary payer coverage and required authorizations to prevent denials and/or reduction in payment for patients entering the facility for care.
</li><li>Obtain necessary paper/electronic referrals, authorizations and pre-certifications from Primary Care Physician and/or Specialty Physician when required by payers, Managed Care, and traditional Medicaid and enters information into the health information system.
</li><li>Collects and validates accurate patient demographic and insurance information, verifies insurance, obtains pre-certification/authorization as required and enters all necessary information.
</li><li>Calculate and communicate patient estimates for hospital services utilizing a deposit matrix or patient payment estimator to determine estimated patient responsibility and communicates financial expectations to the patient.
</li><li>Educates patients on their benefits, offers the patient/family the opportunity to pay their estimated patient responsibility prior to services rendered, and identifies methods of payment available. Identifies patients in need of financial assistance and provides charity applications and referrals to the business office as necessary.
</li><li>Responsible to screen all self pay patients for potential payer coverage and directs applicable accounts to the advocacy team for further review. Assure all payer requirements are met, including non-coverage waivers, Advance Beneficiary Notices, sterilization forms, and other forms as applicable.
</li><li>Provide communication concerning change of insurance coverage, prior to billing, from Registration staff and/or Patient Advocate/Billing staff.
</li><li>Maintain professional development by attending workshops, in-services, and webinars to remain up-to-date on insurance rules and regulations in addition to changes within the industry.
</li></ul><br>
<b>Essential Qualifications
</b><br>
<br>
The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.
<br>
<br>
<b>Required Education, License/Certification, or Work Experience:<br>
</b><br>
<br>
<ul><li>1-3 years Related experience in billing, insurance or registration.
</li><li>1-3 years Healthcare experience
</li></ul><br>
<b>Preferred Education, License/Certification, or Work Experience:<br>
</b><br>
<br>
<ul><li>Associate's finance, business or healthcare.
</li></ul><br>
<b>Expectations and Standards<br>
</b><br>
<br>
<ul><li>Commitment to the daily application of Avera&rsquo;s mission, vision, core values, and social principles to serve patients, their families, and our community.
</li><li>Promote Avera&rsquo;s values of compassion, hospitality, and stewardship.
</li><li>Uphold Avera&rsquo;s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
</li><li>Maintain confidentiality.
</li><li>Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
</li>Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.<br>
<li>
</li></ul><br>
<p></p><p><b>Benefits You Need &amp; Then Some
</b></p><p></p><p>Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.
</p><ul><li><p>PTO available day 1 for eligible hires.
</p></li><li><p>Up to 5% employer matching contribution for retirement
</p></li><li><p>Career development guided by hands-on training and mentorship
</p></li></ul><p></p><p><i>Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to </i><i>talent@avera.org </i><i>.</i></p></div>

Insurance Specialist

AdaptHealth

<div>Description:
<p>
Revenue Cycle Management Specialist are responsible for maintaining a timely revenue cycle for all the goods and</p><p>
services provided by AdaptHealth. Also responsible for maintaining patient confidentiality and function within the</p><p>
guidelines of HIPAA. Completes assigned compliance training and other educational programs as required. Maintains</p><p>
compliant with AdaptHealth&rsquo;s Compliance Program.</p><p><b>
Essential Functions and Job Responsibilities:</b></p><p><b>
Account Receivable</b></p><ul><li>
Ensure organization receives accurate payment for goods &amp; services provided according to contracted rates and/or payer fee schedules.</li><li>
Collect on accounts by sending bills or following up on bills with payers via phone, email, fax, mail, or websites.</li><li>
Reconcile the accounts receivable to ensure that all payments are accounted for and properly posted.</li><li>
Investigate and resolve customer inquiries regarding charges.</li><li>
Monitor patient account details for non-payments, delayed payments, and other irregularities.</li><li>
Communicate with customers regarding insurance, payments, and invoices.</li><li>
Research and resolve payment discrepancies.</li><li>
Identify and verify that billing complies with policies and procedures.</li><li>
Identify trends and root causes related to inaccurate payments and escalate as appropriate.</li></ul><p><b>
Authorization</b></p><ul><li>
Analyze daily requests to determine coverage and approval utilizing criteria.</li><li>
Utilize clinical staff for medial reviews when necessary.</li><li>
Notify staff when authorization is approved or denied.</li><li>
Obtain &amp; enter authorization into database timely &amp; accurately.</li><li>
Collaborates with internal &amp; external customers to provide status updates &amp; coordinate appeals on denied authorization.</li><li>
Resolves pending revenue by reconciling approved authorizations and pending charges.</li></ul><p><b>
Confirmation</b></p><ul><li>
Ensure order will bill correctly to insurance.</li><li>
Ensure order has valid proof of delivery.</li><li>
Address messages on sales order</li><li>
Correct messages as needed.</li><li>
Process order to correct WIP state or confirm order.</li></ul><p><b>
Data Support</b></p><ul><li>
Responsible for the daily claims submissions/printing for all eligible/ready status claims</li><li>
Resolves all claim rejections in a timely manner to guarantee submission within the timely filing requirements of the payers.</li><li>
Identifies claim rejections and escalates as appropriate to facilitate educational opportunities or process improvements.</li><li>
Maintains daily, weekly, monthly system/database functions and performs routine functions as defined by leadership.</li></ul><p><b>
Unbilled Revenue</b></p><ul><li>
Analyze documentation required for billing services and ensure compliance to payer requirements.</li><li>
Resolve pending revenue by reconciling received documentation and pending charges.</li><li>
Requests authorization from state Medicaid programs.</li><li>
Maintains and updates physician databases to ensure accurate delivery of billing documentation and communications with physician offices.</li><li>
Completes accurate documentation of authorization request and follow up activities on each account.</li><li>
Ensures proper payer and system follow up procedures are performed for accurate authorization tracking.</li><li>
Performs extensive account audits and ensures proper billing for services to the accurate payer.</li><li>
Ensures proper revenue recognition for billed charges and services moving forward.</li><li>
Completes all assigned requalification within the set 75-day time frame by having patients retested, picking up equipment when appropriate, or executing ABNs and setting patients up on autopay.</li><li>
Investigate and resolve customer, patient, or physician office, concerns regarding questions while working with the patient through the requalification process.</li><li>
Establish and maintain relationships with key individuals in the regions to support the requalification process setting clear expectations of what is required by the region.</li></ul><p><b>
Patient Financial Services</b></p><ul><li>
Identify trends and root causes related to inaccurate private pay billing, and report to manager while resolving account errors.</li><li>
Investigate escalated customer billing inquiries and take appropriate action to resolve the account.</li><li>
Resolve private pay charges for returned payments due returned payments.</li><li>
Resolve accounts pertaining to patient account inaccuracies or patient demographics.</li><li>
Respond to Collection agency regarding patient disputes of balances owed on accounts.</li><li>
Enroll patients calling regarding financial responsibility and enroll in autopay.</li></ul><p><b>
RCM System (CPTM):</b></p><ul><li>
Responsible for updating data elements that drive revenue generation and decrease denial rates.</li><li>
Work collaboratively with RCM leadership to maximize RCM overall productivity.</li><li>
Adhere to frameworks and maintain documentation appropriately.</li><li>
Assume responsibility for independent completion of tasks and small projects.</li></ul><p><b>
All RCM Specialist responsibilities:</b></p><ul><li>
Educate patients, staff and providers regarding authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance changes or trends.</li><li>
Maintains an extensive knowledge of different types of payer coverage, insurance policies, payer guidelines and payer contracts ensure accurate billing and timely payment is received.</li><li>
Responsible for entering data in an accurate manner, into database including although not limited to payer, authorization requirements, coverage limitations and status of any requalification.</li><li>
Collaborates with physician offices, AdaptHealth sales and support staff to ensure timely receipt of documentationas well as educating, as necessary.</li><li>
Identify trends and providing feedback and education to internal and external customers on compliant documentation requirements for services provided.</li><li>
Develop and maintain working knowledge of current HME products and services offered by the company.</li><li>
Maintain patient confidentiality and function within the guidelines of HIPAA.</li><li>
Completes assigned compliance training and other educational programs as required.</li><li>
Maintains compliant with AdaptHealth&rsquo;s Compliance Program</li><li>
Performs other related duties as assigned.</li></ul>
Requirements:
<p><b>
Competency, Skills and Abilities:</b></p><ul><li>
Decision Making</li><li>
Analytical and problem-solving skills with attention to detail</li><li>
Strong verbal and written communication</li><li>
Excellent customer service skills</li><li>
Proficient computer skills and knowledge of Microsoft Office</li><li>
Ability to prioritize and manage multiple tasks.</li><li>
Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction.</li></ul><p><b>
Education and Experience Requirements:</b></p><ul><li>
High School Diploma or equivalent</li><li>
One (1) year work related experience in health care administrative, financial, or insurance customer services,</li><li>
claims, billing, call center or management regardless of industry.</li><li>
Senior level requires two (2) years of work-related experience and one (1) year of exact job experience.</li><li>
Exact job experience is considered any of the above tasks in a Medicare certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance.</li></ul></div>

Senior RCM Specialist

Orlando Health

<div>Position Summary:
<div><b>
Department:</b><b> </b>Orlando Health Ambulatory - Outpatient Rehab</div><div><b>
Status:</b> Full-Time | 40 hours per week</div><div><b>
Shift:</b> Monday - Friday, 8am - 5pm</div><div><b>
Title:</b>Ancillary Scheudling, Registration, and Patient Charge Specialist</div><div></div><div><b><br>
***Address of Practice: 1222 S. Orange Ave 5th floor Orlando, Fl 32806***</b></div><div></div><div><b><br>
Position Summary</b></div><div>
This position is for our downtown outpatient orthopedic and sports rehab clinic located in the Orlando Health Heart Institute. Responsibilities include patient check in/out, registration, insurance verification/authorization, scheduling, and front office operations.</div><div><br>
</div><div><b>All Inclusive Benefits (start day one)</b></div><div>
Health/Dental/Vision/Life Insurance, Student loan repayment, tuition reimbursement, FREE college education programs, retirement savings, paid paternity leave, fertility benefits, back up elder and childcare, pet insurance, PTO/Holidays, and more for full time and part time employees.</div>
Responsibilities:
<div><b>
Essential Functions</b></div><ul><li>Effective pre-registration, registration and scheduling of multiple patient appointments.</li><li>Manages the multiple additions and cancellations of patient appointments.</li><li>Efficiently and accurately gathers and inputs patient/guarantor demographic and financial information in appropriate hospital</li></ul>
systems
<br>
<ul><li>Contacts appropriate payers/provider offices, verifying benefits and obtaining/documenting necessary authorizations.
</li><li>Consistently and constantly reviews the schedules daily and communicates all changes to appropriate staff.</li><li>Responsible for entry of patient charges.</li><li>Acts as a liaison between the provider and patient to explain insurance benefits, co-pays, deductibles, and self pay portions.</li><li>Accurately communicates all procedure pertinent information including arrival time, location, and duration to the patient.
</li><li>Performs check in and check out of patients.</li><li>Acts as a liaison to the clinical staff.
</li><li>Acts as a liaison to the clinical and business staff to ensure effective and efficient patient management including the transfer of
</li></ul>patients from both outside and sister facilities.<br>
<ul><li>Acts as a resource for training or mentoring of new team members.</li><li>Maintains flexibility in work schedule availability that allows department to change/modify work schedule to meet departmental
</li></ul>needs and on call responsibilities.
<br>
<ul><li>Attends and participates in department staff meetings and attends other meetings as assigned.</li><li>Represents and participates in department, facility, Patient Financial Services and corporate committees as requested by
</li></ul>supervisor/department manager.<br>
<ul><li>Responsible for reviewing and adhering to all corporate departmental and education initiatives.</li><li>Assists his/her supervisor/manager in planning and organizing department activities.</li><li>Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state
</li></ul>and local standards.<br>
<ul><li>Maintains compliance with all Orlando Health policies and procedures.</li></ul>
Qualifications:
<div><b>
Education/Training</b></div><div>
Must be able to demonstrate reading, verbal and written communication, mathematical, and reasoning skills typically acquired
<br>
through completion of a high school education.</div><div><br>
<br>
<b>Licensure/Certification</b><br>
None.</div><div><b><br>
Experience</b><br>
Two (2) years&rsquo; experience in financial, business office, or customer service environment required. Computer knowledge necessary.</div></div>

Ancillary Scheduler - OHHVI Rehab Clinic

Billings Clinic

<p></p><div><p>You&rsquo;ll want to join Billings Clinic for our outstanding quality of care, exciting environment, interesting cases from a vast geography, advanced technology and educational opportunities. We are in the top 1% of hospitals internationally for receiving Magnet&reg; Recognition consecutively since 2006.</p><p>
And you&rsquo;ll want to stay at Billings Clinic for the amazing teamwork, caring atmosphere, and a culture that values kindness, safety and courage. This is an incredible place to learn and grow. Billings, Montana, is a friendly, college community in the Rocky Mountains with great schools and abundant family activities. Amazing outdoor recreation is just minutes from home. Four seasons of sunshine!<br>
<br>
You can make a difference here.</p>
<p><b>About Us</b><br>
Billings Clinic is a community-owned, not-for-profit, Physician-led health system based in Billings with more than 4,700 employees, including over 550 physicians and non-physician providers. Our integrated organization consists of a multi-specialty group practice and a 304-bed hospital. Learn more about Billings Clinic (our organization, history, mission, leadership and regional locations) and how we are recognized nationally for our exceptional quality.<br>
<br>
<b>Your Benefits</b><br>
We provide a comprehensive and competitive benefits package to all full- and part-time employees (minimum of 20 hours/week), including Medical, Dental, Vision, 403(b) Retirement Plan with employer matching, Defined Contribution Pension Plan, Paid Time Off, employee wellness program, and much more.</p>
<p><b>Magnet: Commitment to Nursing Excellence</b><br>
Billings Clinic is proud to be recognized for nursing excellence as a Magnet&reg;-designated organization, joining only 97 other organizations worldwide that have achieved this honor four times. The re-designation process happens every four years.</p><p><b>
Pre-Employment Requirements</b><br>
All new employees must complete several pre-employment requirements prior to starting.</p>
<p><b>Claims Specialist I (Full-time)</b><br>
<b>PATIENT FINANCIAL SERVICES - 120.8855 (ROCKY MOUNTAIN PROFESSIONAL BUILDING)</b><br>
<i>req11626</i><br>
<br>
<b>Shift:</b> Day<br>
<b>Employment Status:</b> Full-Time (.75 or greater)<br>
<b>Hours per Pay Period:</b> 1.00 = 80 hours every two weeks (Non-Exempt)<br>
<b>Starting Wage DOE:</b> $17.00 - 21.25</p><p><br>
The Claim Specialist&rsquo;s main focus is to obtain maximum and appropriate reimbursement for all claims from government and third-party payers. The Claims Specialist is responsible for preparing and submitting timely and accurate insurance claims to government and third-party payers, assisting in the implementation of payer regulations and ensuring compliance to the regulatory requirements, and verifying payments and adjustments are appropriately applied to accounts based on government, contract or other regulations or agreements. The Claims Specialist is responsible for appropriate follow up on all accounts pending payment from government and third-party payers.</p><p><b>
Essential Job Functions</b></p><ul><li>Supports and models behaviors consistent with the mission and philosophy of Billings Clinic and department/service.</li><li>Responsible for submission of timely and accurate claims to primary, secondary, and tertiary insurances for both electronic and paper submission. Generates telephone calls to insurance carriers to follow up on insurance using reports generated for this purpose to ensure the timely collection of money due on the account.</li><li>Audits accounts by verifying that reimbursement amounts are appropriate, coordination of refunds, if appropriate, and coordinating adjustments when necessary, claims appeals or resubmissions, moving balances from insurance responsibility to patient responsibility when appropriate, and reviews and resolves credit balances.</li><li>Ensure that claims have appropriate information on them for submission to insurance companies or agencies by reviewing errors and other prebilling insurance reports/worklists. Analyzes and review claims to ensure that payer specific regulations and requirements are met.</li><li>Prepares and presents verbally and in writing challenges to third party payers for additional reimbursement for denied charges and/or reductions in reimbursement as appropriate.</li><li>Provides guidance and or assistance to the cashiers.</li><li>Provides timely follow-up on correspondence received from the insurance carrier or patient.</li><li>Responds to inquiries from customers/other departments/insurance carriers regarding insurance coverage issues, coordination of benefits, reconciliation of account balances and complaints regarding services received. Initiates appropriate follow-up on outstanding issues.</li><li>Sets up registration and insurance information when necessary.</li><li>Utilizes performance improvement principles to assess and improve quality.</li><li>Identifies needs and sets goals for own growth and development; meets all mandatory organizational and departmental requirements.</li><li>Maintains competency in all organizational, departmental and outside agency environmental, employee or patient safety standards relevant to job performance.</li><li>Performs other duties as assigned or needed to meet the needs of the department/organization.</li></ul><p><b>
Minimum Qualifications</b></p><p><b><i>
Education</i></b></p><ul><li>High School or GED</li></ul><p><b><i>
Experience</i></b></p><ul><li>One year of previous office experience</li><li>Patient accounts or insurance billing experience preferred</li></ul><p><i>
Or an equivalent combination of education and experience relating to the above tasks, knowledge, skills and abilities will be considered</i></p><p></p><p><br>
 <i>Billings Clinic is Montana&rsquo;s largest health system serving Montana, Wyoming and the western Dakotas. A not-for-profit organization led by a physician CEO, the health system is governed by a board of community members, nurses and physicians. Billings Clinic includes an integrated multi-specialty group practice, tertiary care hospital and trauma center, based in Billings, Montana. Learn more at </i><i>www.billingsclinic.com/aboutus</i></p>
<p><i>Billings Clinic is committed to being an inclusive and welcoming employer, that strives to be kind, safe, and courageous in all we do. As an equal opportunity employer, our policies and processes are designed to achieve fair and equitable treatment of all employees and job applicants. All employees and job applicants will be provided the same treatment in all aspects of the employment relationship, regardless of race, color, religion, sex, gender identity, sexual orientation, pregnancy, marital status, national origin, age, genetic information, military status, and/or disability. To ensure we provide an accessible candidate experience for prospective employees, please let us know if you need any accommodations during the recruitment process.</i></p></div>

Claims Specialist I (Full-time)

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