Oneida Health is an independent 101-bed acute care community hospital and a 160-bed extended-care facility (ECF) and short-term rehab facility licensed by the State of New York and operated by Oneida Health Systems, Inc., a New York not-for-profit corporation. The hospital is Joint Commission accredited.
We are proud to share that we have recognized for several national awards based upon safety of care as well as the patient experience of care. The first recognition is provided by The Leapfrog Group, a nationally recognized non-profit organization who reviews 30 patient quality and safety measures and assigns a letter grade to over 2,600 hospitals nationally based upon outcomes. The fall 2019 letter grade for OHC is a “B.”, our eighth consecutive “A” or “B”. Our hospital was also awarded 4 Stars for Patient Experience.
The second recognition is for the Healthgrades Patient Safety Excellence Award. Our hospital is among the top 10% nationally for patient safety and is 1 of only 16 hospitals in New York to receive this award for 2019. The third recognition is for the Healthgrades Outstanding Patient Experience Award. Our hospital is among the top 10% nationally for patient experience and is 1 of only 8 hospitals in New York to receive this award for 2019…with Oneida Health as the only hospital in New York State to receive both awards for 2019! We are also very proud of our CMS 4-Star overall rating for patient experience and CMS 5-Star for quality measures.
The Patient Account Representative – Billing Specialist performs daily activities related to the submission of governmental and third party payer health care services bills, accurately and timely, to support departmental goals and objectives relative to a clean claim submission rate of 85% or greater in accordance with established key performance indicators (KPI’s)
- Claims submissions to governmental and third party payers
- Claims corrections/RTP
- Claims statusing as required
Also assists with collection and follow up activities with third party payers; Medicaid; Medicare; Commercial; HMO’s; and Third Party Liability, as needed, to resolve all outstanding balances and secure accurate and timely payment.
- Net and Gross Days outstanding in Accounts Receivable
- Percent of Accounts receivable aged greater than 90 days
- Cash Collection Goals
- Credit Balances as a Percent to outstanding receivables
- Denials Resolution
1. Assists supervisor in training and education for new staff hires.
2. Monitors payer updates and bulletins and shares with coworkers, supervisors, director and business analyst as appropriate.
3. Works collaboratively and cohesively with the team to assist in keeping workload evenly distributed
4. Reviews assigned claims daily for accuracy –
- Authorization/pre certification noted or requested as needed
- Insurance verification
- Accurate Charges
- Diagnosis is complete
- Unbilled/late charges appropriately managed – contractual vs billed.
5. Performs required edit corrections as applicable and submits claims and rebills to payers in manual and/or electronic format to ensure accurate and timely filing of claims and prompt payment.
6. Reports all recurring rejected claims to management for evaluation of impact on the timely filing of claims.
7. Exercises independent judgment to analyze and report repetitive edit failures so that corrective actions can be taken.
8. Identifies ways to improve billing processes and makes recommendations to Billing and Claims Management Supervisor. Implements and monitors results as appropriate in support of the overall goals of the department.
9. Monitors assigned bill holds and work lists at all sources and insures expeditious resolution. Works with other departmental representatives in resolve. Reports unresolved issues and concerns impeding the billing process and to ensure that filing deadlines are not exceeded.
10. Assists, as needed, with required actions in order to resolve the account balance promptly by submitting appeals, correcting account information, coordinating requests for medical records, requesting posting of account adjustments, requesting an account re bill and any and all other actions necessary to secure account payment. Documents and tracks turnaround time of receipt of any outstanding documents required from external departments.
11. Informs the supervisor of any problems or changes in payer requirements and exercises independent judgment to analyze and report repetitive denials so that corrective actions can be taken.
12. Achieves established productivity standard as determined by the Billing and Claims Management Supervisor. Tracks productivity and provides cumulative reports on a daily, weekly or monthly basis, as required by supervisor.
13. Documents all actions taken on accounts in the system account notes to ensure all prior actions are noted and understandable by others.
14. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact patient account collections. Adheres to internal controls for applicable state/federal laws, and the program requirements of accreditation agencies and federal, state and private health plans.
15. Seeks advice and guidance as necessary to ensure proper understanding.
16. Effectively utilizes payer websites as needed in the execution of daily tasks.
17. Complies with patient confidentiality policies for the retention of patient health information, or when handling, distributing, or disposing of patient health information.
18. Performs other duties as assigned by the Supervisor.
19. Handles telephone information with courtesy, accuracy, and respect for confidentiality; receives information and distributes messages appropriately.
20. Consistently communicates appropriately with patients and staff and responds to requests for assistance promptly.
21. Provides accurate communication in verbal, nonverbal and written form. Listens effectively.
22. Communicates effectively with supervisor and team members, including but not limited to changes of operation. Reports to supervisor regularly on the status of ongoing projects.
23. Follows proper chain of command appropriately to resolve problems and concerns.
24. Treats patients and their families with respect and dignity, and ensures confidentiality of patient records.
25. Provides positive and productive support to the team and promotes teamwork. Is kind, courteous, respectful and professional in all interactions with all hospital personnel at all levels.
26. Other duties as assigned.
- 37.5 hours per week, Monday-Friday
- High School diploma. Degree or additional applicable education and/or certificates highly preferred.
- Five + years’ experience directly related to health care inpatient and outpatient billing.
- In depth knowledge and familiarity with healthcare medical terminology, billing and coding
- Intermediate knowledge base of the reimbursement guidelines for all major third party and governmental payers; Medicaid, Medicare, HMO’s; Commercial, Worker’s Compensation and Third Party Liability.
- Good communication, technical and interpersonal skills.
- Proficiency in use of PC and Microsoft Office Suite use and application and use of internet.
- Proficient knowledge base of patient accounting systems.
- Understands and complies with HIPAA and Protected Health Information rules and regulations.