The position is responsible for balances due from patients, insurance carriers, and third-party payers. Team member will collect patient payments, set up payment plans and payroll deductions from team members, follow-up on outstanding insurance denials, work claim error in the clearinghouse system, and post patient and insurance payments for Home Care/Hospice accounts.

RESPONSIBILITIES (ESSENTIAL FUNCTIONS):

• Accurately posts payments and creates payment plans for upcoming services and/or outstanding balances.
• Reviews balances and communicates to patient and other affected parties about outstanding balances.
• Assists patients in resolving account questions and concerns.
• Responsible for coordinating and completing financial assistance application for charity care program.
• Responsible for understanding the revenue cycle, including all involved parties and appropriate escalation pathways.
• Contacting payers, via website, phone and/or correspondence, regarding reimbursement of unpaid accounts over thirty (30) days or more, also researching and following up on denials and requests for additional information.
• Interpret Managed Care/Commercial contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection.
• Make necessary adjustments as required by plan reimbursement.
• Performs payment validation by utilizing internal and/or external resources to ensure proper reimbursement.
• Reviews, researches, and appeals partially denied claims for reconsideration.
• Responsible for contacting patients to gain additional information required to resolve an outstanding insurance balance.
• Responsible for posting payments both electronically and manually.
• Analyzes, investigates, and resolves claims errors in the clearinghouse system to ensure claims are filed to carriers timely.
• Regular attendance and punctuality for scheduled shifts.
• Maintains professional and technical knowledge through continuing education opportunities including internal and external educational offerings.
• Must adhere to safety protocols at all times.
• Per DRH policy, all required conditions of employment must be met and maintained including required vaccinations.
• Implement DRH Standards of Behavior and exhibit behaviors consistent with DRH core values.
• Performs other related duties as assigned.