Process Medical Accounts Receivables by maintaining ledgers, compiling, consolidating, checking and arranging funding data.
Generate and submit medical claims to insurance companies ensuring all set rules, regulations, and/or procedures are adhered to.
Strategies, policies and procedures will be developed for Government review and approval.
Train contractor staff members upon government request on accounting, budgeting, third party collections or other financial programs
Maintain account receivable records, claims, billing receipts and history files.
Develop and maintain tickler files for tracking delinquent accounts receivables.
Track and process all overdue Medical Accounts Receivables.
Prepare letters to organizations to request payment on delinquent Medical Accounts Receivables
Develop a process to track and maintain a file of these letters and the result collections.
Provide guidance to internal and external contacts and insurers regarding questions concerning patient medical claims.
Act as point of contact between private insurance companies regarding Accounts Receivables actions.
Research, extract and summarize reimbursable information, submitting all reports to the Government.
Post, examine, balance, and extract data from records to prepare reports.
Examine documents for accuracy, adequacy of documentation, and compliance with regulation for timely collection of third party insurance accounts.
Screen and review information to ensure documentation requirements for medical records are met.
Provide any documentation of appropriate action
Perform a quantitative review of the medical record for completeness ensuring that everything that is supposed to be there is present, signed and dated to include the occurrences screening checklist.
Retrieve medical records and other data for research projects and for diagnostic, training or review purpose.
Answer telephone inquiries from within WRNMMC regarding patient status, admissions dispositions, length of convalescence and transfer status.
Contractor staff members will be trained as needed on accounting, budgeting, third party collections or other financial programs as required.
Submit inpatient and outpatient claims, reviewing inpatient and outpatient claims, making followup calls as necessary.
Collect, organize and prioritize data, files and claims in a timely manner. File claims appropriately stamping correct code on inpatient and outpatient claims.
File claims appropriately stamping correct codes on inpatient and outpatient claims.
Pre-cert all inpatient and APV claims within 48 hrs.
Work together with the Utilization Review nurse for clarity information on patient stay.
Train new employees on the billing system.
Print UB-04 and CMS 1500 forms to resubmit claims to the insurance companies. Electronic sent claims daily to the insurance companies using the billing system.
Screen and review information to documentation requirements for medical records are met.
Provide any documentation of appropriate action.
Coordinate the performance and daily distribution of identification and collection of Other Health Insurance (OHI) patient information for all billable clinics that support the Uniform Business Office (UBO) revenue generation for WRNMMC.
May Communicate with Administrative coordinators throughout the hospital on Outpatient Itemizes Billing (OIB) procedures to ensure that optimal reimbursement is attained for their respective.
Train clinics personnel on the proper procedure use of the DD-2569 forms
Educating and training other (patients’ clinical staff members, managers) on the importance of the OHI program regarding the
patient’s DD 2569 forms.
Train others in utilizing the installed clinic scanners (which scan the patients’ insurance card).
Aggressively follow-up with third party payer on billed claims that are more than 30, 60, 90 and 120 days or more to ensure payment is received for insurance carriers on claims in a timely manner.
Reconcile accounts accurately in a timely manner in ARMS PRO/General Ledger according to the UBO guidelines and the patients’
specific health benefits policy.