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Description:

REMOTE OPPORTUNITY - Detroit, MI

As a mission-driven innovative health organization, we will become the national leader in improving the health of our communities and each person we serve. By demonstrating reverence, commitment to those who are poor, justice, stewardship, and integrity, our organization will continue to provide better health, better care, at lower costs.

The primary purpose of your job position as the Billing and Collections Representative I is reviewing, researching, and processing claims in a timely and efficient manner. This role is focused on accelerating cash flow by ensuring that payers and/or residents accept claims for resolution and that all unresolved claims are consistently followed up on. All duties are expected to be completed in accordance with existing contracts, regulations and policies while maintaining the quality and productivity standards expected of the Billing and Collections Representative I.

Prepares batches from the EMR for upload into the billing scrubber. Updates/corrections information identified via rejections from the billing scrubber or other payer edits (ex. Medicare Return to Provider) and retransmits until payer acknowledges receipt

Follows up with payers using online tools or the phone to check the status of claim and escalate as necessary to push each one toward timely resolution.

Identifies routine payer, provider, or technical issues and escalates to Billing and Collection Manager Identifies, researches, and resolves issues related to eligibility, authorization, coordination of benefits, timely filing, etc., leveraging peers or manager as needed to ensure timely resolution.

Posts cash and/or facilitates the posting of electronic remittance advices in a timely fashion and performing related reconciliation steps to ensure everything is in balance Investigates balances remaining after payment (i.e,. payment variances) to determine if they are a result of denials or under/over payments and takes appropriate action to resolve the discrepancy (ex. appeal denial, issue a refund, request a write-off).

Acts as a point of contact for assigned payers, communities, etc. Evaluates accounts, submits claims, and performs adjustments, write-offs, and/or balance reversals, if charges were improperly billed or if payments were incorrect. Updates and refiles claim forms in a timely, accurate manner.

Communicates with Admissions, Business Office Managers, Regional Managers of Business Office Operations, clinical liaisons, physician offices, and residents, to clarify billing discrepancies, and obtain demographic, clinical, financial, and insurance information needed to process and resolve the claim.

Performs all routine follow-up functions, including the investigation of overpayments, underpayments, credit balances, and payment delays. The objective is to maximize reimbursement for services rendered and ensure the claim is paid or settled in a timely manner. Researches claim rejections and/or denials and makes corrections, takes corrective actions, and/or refers claims to appropriate colleagues or manager to ensure timely claim resolution.

Proactively follows up on delayed payments by contacting third-party payers and/or residents as necessary to determine the cause for delay and to push for resolution.

Promptly and accurately posts or uploads hardcopy or electronic remittance advices to relieve AR.

May prepare special reports as directed by the Billing & Collection Manager to quantify and/or track known issues or populations. Interprets data, draws conclusions, and reviews findings with Billing and Collections Manager for further review.

Takes initiative to continuously learn all aspects of the Billing and Collections Representative role to support progressive responsibility.

Maintains a working knowledge of applicable Federal, State, and local laws and regulations, THSC Corporate Integrity Program, Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.

In light of a disaster will know your disaster recovery, crisis management and business continuity plans and act within your role that is developed within the business continuity plan, which may include working at another location, remotely from home, and maintaining constant contact with key personnel.

PERFORMANCE METRICS

As part of ongoing, on-the-job performance evaluation, colleagues will be expected to achieve pre-determined productivity standards and quality scores through periodic performance reviews. Additional metrics beyond quality and productivity may also be used to determine satisfactory performance and assist in progressing individuals through the position career ladder.

MINIMUM QUALIFICATIONS

Must possess a comprehensive knowledge of health insurance and governmental programs, regulations, and billing processes, e.g., Medicare, Medicaid, Social Security Disability, managed care contracts and coordination of benefits as normally obtained through an associate's degree in accounting or business administration or a related field and a minimum of one year of relevant experience. A combination of education and experience may be acceptable. Past work experience includes experience within a Skilled Nursing Facility, hospital, or clinic environment, a health insurance company, managed care organization or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting, or customer service activities is highly desired. Must be action-oriented, have business acumen, manage conflict well, be customer focused, have high decision quality, flexibility to adapt to ongoing change and have organizational agility. Ability to work with minimal supervision and exercise independent judgment. Demonstrates superior written and verbal communication and presentation skills appropriate for audience comprehension. Well-developed communication skills, both written and oral, that may be used either in an on-site or virtual environment is required. Able to communicate effectively with individuals and groups representing diverse perspectives. Comprehensive to expert proficiency with Microsoft product suite (MS Word, Excel, Power Point, etc.); basic knowledge and experience with electronic mail and calendaring system. Knowledge of HealthMedEx, Vision, e-Solutions, and Zirmed systems experience preferred. Ability to type with speed and accuracy. Ability to use other software as required to perform the essential functions of the job. Possesses a high degree of personal accountability, responsibility and independent decision making abilities with the skills to interpret programs, goals, objectives, policies and procedures of the organization in line with mission, vision, and philosophy of THSC. Excellent organizational skills. Ability to perform multiple duties and functions related to daily operations and maintain excellent customer service skills. Ability to perform frequent detailed tasks and provide immediate service with frequent interruptions. Ability to change and be flexible with work priorities. Strong problem solving skills.

Ability to research, analyze and assimilate information from various on-site or virtual sources based on technical and experience based knowledge. Must exhibit critical thinking skills and possess the ability to prioritize workload

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.