Payment Resolution Rep

Reports to the Manager, Patient Accounting. Under the guidance of the Coordinator of Cash Application Services, is responsible for the application, posting, reconciling, and balancing of all cash transactions, adjustments, combinations and transfers. Calculates, reviews and researches contractual claims by third party payors. Researches unidentified payments. Investigate missing payments. Prepares reports and makes appropriate copies of postings. Prepares and logs bank deposits for balancing.

MISSION, VALUES and SERVICE GOALS

• MISSION: We deliver outstanding care, inspire health, and connect with heart.
• VALUES: Trust. Respect. Integrity. Compassion.
• SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team

Ensures The Application, Posting, Reconciling And Balancing Of All Cash Transactions, Maintains Appropriate Balancing Reports And Performs Cashier And Research Functions In Accordance With Established Policies, Procedures And Control Measures And Utilizing Star/ Contract Management System By

• Receiving, sorting, batching and totaling patient and insurance company checks.
• Preparing patient checks, insurance checks and payment listings for posting, balancing and depositing.
• Posting all payments, contractuals, transfers, combinations and refunds on the data system within a 48-hour window.
• Balancing daily postings and reporting the deposits and postings to the Finance Department.
• Downloading the electronic cash posting remittance advices, preparing the remittance for posting, previewing, posting and running the appropriate reports.
• Investigates the source of unidentified payments to ensure they are applied to the appropriate accounts.
• Investigate deposits without remittances, obtains remittance from the payer and posts the payment.
• As a resource to staff when troubleshooting payment issues. Works to a resolution.
• Researching and resolving payment issues.
• Calculating, reviewing and researching contractuals claimed by third party payors. Works collaboratively with Cash Application/ Contract Management Coordinator to ensure accurate posting.
• Calculating and posting co-pays and deductibles to enable the Pathways Contract Management System to identify payment variances.
• On daily basis, interacting with patients, guarantors, third party administrators, insurance companies, employers and governmental agencies to resolve remittance advice and payment issues.
• Enter insurance billing information and creating insurance logs based on payment explanations.
• Telephoning, receiving, reviewing and sending correspondence and otherwise researching all non-patient cash received to properly determine ownership.
• Identifying, documenting and manually correcting problems with electronic software processes and collaborating with software vendor and Information Systems to resolve posting issues.
• Researching and resolving the lowest possible amount of unapplied cash on a weekly basis.
• Identify NPIs not enrolled in EFT/ERAs and completes the steps to get them enrolled ensuring that payments and remits are coming through as expected.
• Enrolling new sites and providers in EFT/ERAs.
• Notifying payers as needed to ensure that they are sending remits to the correct address.
• Works worklist in Cerner related to this role.

Performs preliminary patient accounts receivable and bank financing functions in accordance with established policies and procedures by:

• Answering account inquiries and resolving questions or problems at the Cashier's window.
• Documenting financial arrangements in the Star system, including payment plans, payroll deductions, and payment problems or variances, including the action taken.
• Reviewing the patient's account, accepting payment and issuing a receipt.
• Setting up patient payment plans, team member payroll deductions, explaining bank financing, determining prompt pay discounts and explaining new Hospital policies regarding payments.
• Obtaining and forwarding to Billing Services all third-party reimbursement information and other data ensuring the prompt and proper billing of patient accounts.
• Forwarding or coordinating the mailing of itemized statements, UB-04 forms, medical records information and other account information.

Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by:

• Assisting the Patient Accounts Services staff and other departments in the research and resolution of patient account payment posting problems.
• Completing other job-related duties and projects as assigned.

Organizational Responsibilities

Associate complies with the following organizational requirements:

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established timeframes.
• Completes annual employee health requirements within established timeframes.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

Commitment to Beacon's six-point Operating System, referred to as The Beacon Way:

• Leverage innovation everywhere.
• Cultivate human talent.
• Embrace performance improvement.
• Build greatness through accountability.
• Use information to improve and advance.
• Communicate clearly and continuously.

Education And Experience

• The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a high school diploma or equivalent. Three years of healthcare payment posting experience is required.

Knowledge & Skills

• Requires thorough knowledge of third party payor practices and procedures, as well as managed care contracting, as it relates to manual and electronic posting and automated information systems.
• Requires math aptitude to perform semi-complex balancing routines and simple accounting procedures, including the ability to compute charges, count money and balance postings and deposits.
• Requires well-developed clerical skills, the ability to type a minimum of 30 wpm and the ability to effectively operate standard office equipment specific to the department's needs.
• Demonstrates proficiency in basic computer skills (i.e., data entry, word processing, database applications, and spreadsheets).
• Demonstrates well-developed interpersonal skills necessary to effectively interact with a diverse group of patients, visitors, vendors and staff members courteously and professionally that is consistent with Memorial Health System's mission and values.
• Demonstrates the ability to communicate verbally in a clear manner in order to provide effective explanations.

Working Conditions

• Works in an office environment.
• Must be able to be effective in a fast-paced, quality-focused, multi-priority environment that frequently deals with decision-making, stressful conditions, and deadlines.

Physical Demands

Requires the physical ability and stamina (i.e. to sit/walk for prolonged periods of time, lift up to 15 pounds, occasionally stoop, bend, twist, reach, etc.) to perform the essential functions of the position.