1. Job Responsibilities

• Review each assigned account to ensure that the account balance is accurate, verifying that all correct steps have been completed by the previous departments to ensure that no billing/claim errors have occurred and the balance on the account is correct. Ensure that remaining variances are categorized as a potential over or
• Verify the contracted rates and compare them with the insurance payment when the payor (insurance) is contracted with the hospital. Appeal variances to the insurance company for additional payment according to the contracted rates. For non-contracted payors, ensure the payor knows that the total claim charge is
• Complete manual adjustments, contract overrides and allowances as needed for accounts in which the system cannot properly adjudicate, including debit and credit
• Perform appeals for underpayments based upon contract terms with regular follow up until account is
• Consult with Managed Care to review unclear contract
• Submit requests to update systems timely upon rate change effective dates as needed
• Reprorate accounts through systems for corrected pricing, including debit and credit
• Perform daily reconciliation and edit resolution on exception
• Complete daily credit balance review. Update status of accounts and submit to appropriate person for refund
• Coordinate and monitor all month end activities including month end work
• Complete clean month end close in all systems and meet close
• QA and approve revenues
• Coordinate all Payor Master activity. This includes but, is not limited to, assigning and auditing payor codes and profiles. Manage and maintain the Payor Master including payor
• Ensures team has processed all payor code related changes to patient accounts including Payor Master add/edit requests, Letter of Agreement uploads, and Medicare exhaust updates within policy
• Perform various facility and departmental systems and procedures audits, identifying improvements for revenue
• Perform revenue reviews as needed and requested for hospital, finance, or CBO teams. Respond timely and accurately to each
• Maintain the accounting adjustment
• Complete required reviews and month end reporting for internal audit compliance
• Obtains approval prior to posting and accurately posts all zero pay remits in which payments are applied to an over pay
• Complete all requests required for audits
• Escalates any and all issues preventing revenue accuracy. Ensures these issues are resolved prior to month
• Complete revenue review on all admissions for revenue accuracy within three days of admission and concurrently throughout the stay
• Complete revenue review on all discharges for revenue accuracy within three days of
• Complete all post payment variance reviews within 3 days of payment on both interim and admit to discharge account
• Develop analytical reports needed to complete revenue reviews for specific situations
• Review historical payer data to ensure consistency in revenue recoding on accounts and determine when changes to process may be
• Respond to and log all close review requests from corporate representatives
• Report critical revenue impacts to VP of Revenue Cycle

2. Customer Service

• Maintains the highest level of customer service via courtesy, compassion and positive
• Promotes the Mission and Vision of Post Acute Medical within the work environment and the
• Respects dignity and confidentiality by adherence to all applicable policies and
• Provide support to all facilities when requests are received or assistance is needed. Be timely and responsive to all requests. Treat our facilities as customers and provide superior customer service to

3. Health and Safety

• Works in a manner that promotes safety; wears clothing appropriate to the performance of the
• Participates in OSHA required
• Follows universal precautions as appropriate for position; complies with Employee Health requirements for continued
• Reports unsafe practices to
• Knows own role in case of an emergency

POSITION QUALIFICATIONS:

Education and Training: High School diploma or equivalent required.

Experience:

• Proficient in use of Microsoft Word, Excel, Access and Outlook. Good interpersonal skills. Ability to provide positive customer service. Ability to maintain independent work schedule. Ability to work collaboratively with team members. Ability to be organized with attention to detail. Good math, analytical and problem solving skills. Data entry and 10-key by touch. 2-3 years of related experience in cash posting and reconciliation, EOB analysis, balance transfers, posting refunds, misc. cash, write offs and contractual adjustments.

Knowledge, Skills, and Abilities:

• Overall knowledge of business
• General knowledge of third payers, and billing procedures and
• Experience with automated patient accounting systems and automated billing and collection
• Type 50
• Operate personal computer, 10-key.
• Excellent telephone and customer service

PHYSICAL DEMANDS: See attached Job Activity Requirements in addition to the below.

• Sedentary Work: exerting up to 10 pounds of force occasionally, or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body. May involve sitting most of the time, but may involve walking or standing for brief periods of time.
• Sitting or standing, bending, stooping, and the ability to carry items weighing up to 20
• Constant adequate range of motion and mobility
• Regular near acuity with clarity of vision at 20 inches or less
• Typical ability to collect and analyze numerical and written data and verbal information to reach logical conclusions and ability to determine the time, place and sequence of operations or actions
• Regular talking and the ability to express and exchange ideas by means of language
• Regular hearing and the ability to perceive the nature of
• Constant ability to read, record, or type data quickly and accurately

WORKING CONDITIONS:

• Inside in well-lighted, well-ventilated

• Working long hours between breaks or meals required

• Must be willing to travel overnight to various locations as
• Ability to work under and handle stress in an appropriate manner
• May be exposed to high, medium, or low noise
• Constant contact with third-parties, co-workers and guests
• Category 3 – Job tasks involve no greater exposure to blood, body fluids, or tissues than would be encountered by a The normal work routine involves no exposure to blood, body fluids or tissues and the worker can decline to perform tasks without retribution.
• Ability to work long hours during monthend close and for weekly revenue reviews

ORGANIZATIONAL DATA: This is a non-exempt position, supervised by the RCO Manager. No formal line(s) of promotion exists.