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 spring 2019 letter grade for OHC is a “B.”, our seventh consecutive “A” or “B”.
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.
Patient Account Representative – SNF Billing/Collections Specialist performs all billing, collection, and follow up for all third party payers, private pay, and NAMI payments to resolve all outstanding balances and secure accurate and timely payment. This position is responsible for supporting and contributing to the team efforts in achievement of pre-established key performance indicators.
This position reports to the Patient Financial Supervisor and works closely with both the Supervisor and Billing/Collection Coordinator to ensure billing and reimbursement data is accurate and maintained in our HIS (Point Click Care) and billing and collection activities are completed so as not to exceed any timely filing limits.
Responsibilities and Duties
- Ensure all claims are submitted based on established guidelines with goal of zero errors.
- Performs daily collection activities which include on line status as well as contacting payers to follow up on outstanding claim balances for assigned payers. Clearly document in the PCC system the payment status of the account and/or actions to secure payment.
- Reports unresolved issues and concerns impeding the billing/collection process to the Patient Financial Services supervisor to ensure that timely filing deadlines and not exceeded.
- Develop good working relationship with all payer reps and reach out to them for assistance with any issues timely and as appropriate.
- Responds timely to inquiries by insurance companies.
- Responds to claim denials from payers such as inability to identify the patient, coordination of benefits, non-covered services, past timely deadlines and ensures all information is provided to the payer that is required to process payments within 48 hours of receipt.
- Performs required actions in order to resolve the account balances promptly by submitting appeals, correcting account information, coordinating requests for medical records, posting account adjustments, generate rebills as necessary and any and all other actions necessary to secure account payment without exceeding timely filing limits.
- Performs routine audits of assigned accounts to resolve all discrepancies in account balances (e.g. credit balances, underpayments, inaccurate adjustments) and performs necessary actions to resolve the account balance.
- Meet with Billing Coordinator/Supervisor to discuss and resolve reimbursement issues or billing obstacles as needed.
- Knowledge with in and out of network insurances, Workers Compensation, insurance verification, patient responsibility, and process for prior authorization.
- Knowledge of interpreting EOBs, posting payments, and adjusting accounts appropriately.
- Increases revenue by collecting payments on outstanding accounts.
- Manage the status of accounts and identify inconsistencies.
- Monitor payer updates and bulletins and share with coworkers, supervisor, and director.
- Maintains knowledge of applicable rules, regulations, policies, laws and guidelines related to SNF billing and collection.
- Adheres to internal controls for applicable state/federal laws, and the program requirements of accreditation agencies and federal, state and private health plans.
- Identify ways to improve billing and collection processes and makes recommendations to Patient Financial Services Supervisor. Works with team to implement and monitor results as appropriate in support of the overall goals of the department.
- Any additional duties as requested by management.
Additional Knowledge, Skills, and Abilities
- Handles telephone information with courtesy, accuracy, and respect for confidentiality; receives information and distributes messages appropriately
- Consistently communicates appropriately with patients and staff and responds to requests for assistance promptly.
- Provides accurate communication in verbal, non-verbal and written form. Listens effectively.
- Communicates effectively with supervisor, including but not limited to changes of operation. Reports to supervisor regularly on the status of ongoing projects.
- Assists with orientation of new staff.
- Follows proper chain of command appropriately to resolve problems and concerns.
- Treats patients and their families with respect and dignity, and ensures confidentiality of patient records.
- 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.
Qualifications and Skills
- 3 to 5 years of recent Skilled Nursing Facility (SNF) billing experience.
- Medicare and Medicaid SNF billing experience required.
- Knowledge of working SNF denials both on the front and back end of the billing process.
- Proficiency in use of PC, Microsoft Office Suite and application and use of the internet.
- Good communication, technical, organizational and interpersonal skills.
- Familiarity with medical terminology.
- Knowledge of PDPM reimbursement model.
- Ability to communicate with various insurance payers; work with and communicate with a multidisciplinary team.
- Experience in filing claim appeals with insurance companies to ensure maximum reimbursement.
- Responsible use of confidential information.
- Strong written and verbal skills.
- Ability to multi-task.
- High School diploma or equivalent; Degree or additional applicable education and/or certificates highly preferred.
- Three to five + years’ Skilled Nursing Facility billing and collection preferred.
- Experience with Point Click Care (PCC) HIS preferred.
- 37.5 hours per week, 8AM – 4PM, Monday-Friday