Job Description
Job Description
Job Objective:
Under the supervision of the Vice President of Revenue Cycle or designee, performs patient account follow-up, credit balance review and resolution, keeping the hospital's accounts receivable as accurate as possible.
Duties and Responsibilities:
· Insurance follow-up, as assigned.
· Contact insurance carriers regarding outstanding balances until resolution.
· Resubmit claims with the appropriate remarks and/or attachments as needed.
· File insurance reconsideration letter for payment and/or denial disputes.
· Validate accounts for accurate payments, discounts, and contractual adjustments.
· Reply to insurance carrier correspondence as appropriate.
· Run insurance eligibility and correct claim before resubmission as needed.
· Pull supporting documents for annual regulatory audits, as needed.
· Ensure credit balance and refund requests are reviewed and resolved timely.
· Answer in-coming calls resolving patient and/or insurance issues timely.
· Assist with other duties as assigned, within skill sets and abilities.
Education
High School graduate or equivalent
Experience
Minimum 1-year Commercial, HMO, PPO, and Workers Compensation billing and/or
Insurance follow-up experience.
Working knowledge of HMO, PPO, Commercial, and Workers' Compensation reimbursement.
Working knowledge of Managed Care contract language and interpretation.
What Should I Know About Hialeah Hospital?
Our 378-bed acute care hospital opened in 1951 to serve the Hialeah, Florida community. Our team is committed to honoring the trust that our patients place in us by providing compassionate, safe, high-quality care in the right place, and at the right time.
Hialeah Hospital has been honored to receive a number of awards and designations for our superior health care services, including:
Cardiac
American Heart Association Get with the Guidelines - Heart Failure Gold Plus Award, 2018
American Heart Association Get with the Guidelines - Target Stroke Gold Plus Award, 2018
Bariatric
American College of Surgeons/American Society for Metabolic and Bariatric Surgery - MBSAQIP Accredited Center
BCBS - Blue Distinction Specialty Care Bariatric Surgery, January 2018
Neurology
Advanced Primary Stroke Center Re-accreditation, April 2018
Women's Services
American College of Radiology granted Stereotactic Breast Biopsy Re-accreditation, March 2016
Hyperbaric Unit
Healogics Center of Distinction Award, 2017
Laboratory Services/Blood Bank
Certificate of Accreditation from College of American Pathologist