Provides medical collection services for TLRA collection units. Utilizes a strong background as a medical collection specialist to successfully resolve accounts placed with TLRA for collection.
This involves performing collection activities related to follow-up and account resolution, and includes communication to patients, clients, reimbursement vendors, and other external entities while adhering to all client, state and federal guidelines. Patient and client satisfaction is essential. Associates in the collection unites are expected to knave knowledge of the overall collection work processes for the both active AR and BD inventory.
* Provides effective collection services, ensuring the successful recovery of accounts in accordance with client and state guidelines as well as TLRA's business objectives * Understands and adheres to all policies and procedures, as well as local, state and federal regulations, relevant to their area of operation. * Documents and updates patient account information in TLRA's collection software system timely and accurately to include appropriate account status. * Handles inbound patient and/or carrier calls promptly and professionally, providing assistance and resolution to account inquiries, issues and request. * Uses collection tools effectively to ensure quality recovery services and meet or exceed established goals and work standards. * Performs research and analysis of account issues and strives to resolve problems timely and accurately. * Ensure daily productivity standards are met. * Promotes positive patient relations by communicating in a manner that demonstrates respect for the human dignity of patients and/or their families. * Performs other special projects as required when assigned.
Collections -- Traditional Government Insurance * Maintains actvie knowledge of all collection requirements by payors. * Collects balance owing from third party payers in accordance with State and Federal laws governing collections practices. Ensures that colletion efforts are thorough with overall objective being to collect outstanding balances in an eithical manner. * Ensures established quality standards are met and proper documentation regarding patient accounting records. * Contacts other departments to obtain necessary information for appeals, pending informaton and any other issues that impact and/or delay claim processing. * Provides effective and timely collection services ensuring the successful recovery of accounts in accordance with client and state guidelines as well as TLRA's business objectives. * Validates claim payments to ensure claims are paid according to contract and/or payment methodology guidelines. * Correct claims in RTP status in either CCSM or DDe per Medicare guidelines. * Initiate Medicare Redetermination, Reopening, and/or Reconsideration as needed.
A. Education/Skills * HS Diploma or equivalency required * Post HS education preferred
B. Experience * Must have minimum of 3 years' experience with Medicare/Medicaid insurance billing, collections, payment and reimbursement verification and/or refunds. * Experience with the Medicare billing process * Thorough understanding of Medicare/Medicaid guidelines and procedures for billing, collections and appeals. * Understanding and exposure to Medicare Recovery Audit Contractor * Knowledgeable in locating and referencing CMS and/or Medicare Regulations * General hospital A/R accounts knowledge is required. * PC skills in a Windows environment are required. Solid knowledge and utilization of desktop applications to include Word and Excel are essential. * College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.
C. Licenses, Registrations, or Certifications None required
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.