Remote position – must be local to the DMV area
Resolves A/R stagnation and other issues caused by insurance entry errors created largely by pre-arrival (Scheduling, Registration) or arrival (Check-in) associates. Duties are typically centered on system-generated queries and edit reports which allow the representative to take proactive steps to resolve insurance verification and eligibility issues across all of the patients billing groups and invoices, thus increasing reimbursement levels as well as greater patient satisfaction. Receives and handles correspondence concerning insurance verification, eligibility and registration via mail, web and fax. Answers calls concerning insurance editing, verification and registration matters within a queue of the MPBS Customer Service ACD Call Center. Contributes to the success of the ACD Call Center team environment by being mindful of traffic patterns and meeting established standards. Educates patients about insurance eligibility and benefits issues. Requests and accepts payments while speaking with callers. Uses appropriate MedStar and MPBS guidelines to make best practice decisions concerning proper resolution of each individual case with special emphasis on building rapport, enhancing the patient experience and service recovery. Entrusted with a high level of system training and access such that nearly all patient verification issues will be resolved at the level of this single point of contact.
Primary Duties and Responsibilities
Communicates to MPBS leadership any system or procedural problems/inconsistencies to ensure prevention of problem recurrence or to improve existing processes.Completes annual mandatory training (SITEL) within defined time frame. Attends training sessions, workshops offered, staff meetings and work events.Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards and safety standards. Complies with governmental and accreditation regulations.Documents all actions on customer account in GE IDX system.Exemplifies Spirit Values in all activities in areas of service, resource utilization, high quality outcomes and effective communication.Extrapolates from each situation the potential implications for the alternate receivable or external entities and recommends action and/or works with patients to resolve.Handles daily Claims and TES edits via GE ETM views related to incorrect insurance information on patient accounts which require proactive steps to immediately update accounts so claims can be submitted if applicable.Handles system generated query reports aimed at discovering invoices/accounts in need of registration and/or insurance update so claims submission and/or resubmission can be performed (Medicare Crossover, Self Pay Possible Status, Un-named infant Report, Statement Edits, Fsc Edit and EScan Reports, to name a few).Identifies the nature and origin of each issue, Hospital, Physician or Radiology, making distinctions between issues that require more research and follow up from leadership or another area. Must be knowledgeable of insurance eligibility and Managed Care issues vs. research inquiries that may require referral to another unit for resolution.Keeps abreast of regulatory and specific changes as it relates to HCFA 1500 billing requirements and payer specific follow up.Participates in multidisciplinary quality and service improvement teams as appropriate. Participates in meetings, serves on committees and represents the department and hospital/facility in community outreach efforts as appropriate.Performs other duties as assigned.Possesses extensive knowledge of managed care insurance contracts and the associated rules for claims processing and reimbursement such that actions can be taken and recommendations can be made regarding non-participating carriers, non-billable elective services or untimely filed services.Receives and resolves inbound inquiries – via phone and mail – from customers with insurance and eligibility concerns and issues.Receives and resolves inbound inquiries – via phone and mail – from customers with insurance and eligibility questions.Requests and receives payments during incoming calls as needed.Uses multiple resources, including SMS (HDX) Invision, Navinet and various other insurance carrier websites to take action on accounts to avoid the generation of additional (or initial) incorrect patient liability statements which lead to a poor patient experience and A/R stagnation. (Activities enhance the patient experience and increase speed and level of reimbursement for MedStar).
Minimum Qualifications
Education
- High School Diploma or GED required
- Associate’s degree preferred
- Bachelor’s degree preferred
Experience
- 3-4 years physician billing experience, accounts receivables management experience required
- 2 years of customer service experience in the health care industry preferred
Knowledge, Skills, and Abilities
- Excellent verbal and written communication skills.
- Advanced ability to handle challenging personalities and ability to diffuse confrontational situations.
- Computer literacy is required, with experience in GE IDX, ETM, and/or Invision strongly preferred.
- Advanced knowledge of multiple insurance verification procedures and applications.
- Ability to research current issues utilizing historical data and resources to come to proper conclusions and decisions.
- Advanced knowledge of payers submission requirements.
- Knowledge of Managed Care contracts.
- Comprehensive understanding of ICD-9/10, HCPCS and CPT coding.
- Ability to work in a team-oriented environment. Proficient in Microsoft office products.
- Ability to work and thrive in a stressful team oriented production and deadline driven work environment, managing multiple projects and assignments in a timely successful manner.
Why MedStar Health?
At MedStar Health, we understand that our ability to treat others well begins with how we treat each other. We work hard to foster an inclusive and positive environment where our associates feel valued, connected, and empowered. We live up to this promise through:
- Strong emphasis on teamwork—our associates feel connected to each other and our mission as an organization. In return, our effective team environment generates positive patient outcomes and high associate satisfaction ratings that exceed the national benchmark.
- Strategic focus on equity, inclusion, & diversity—we are committed to equity for all people and communities. We continue to build a diverse and inclusive workplace where people feel a sense of belonging and the ability to contribute to equitable care delivery and improved community health outcomes at all levels of the organization.
- Comprehensive total rewards package—including competitive pay, generous paid time off, great health and wellness benefits, retirement savings, education assistance, and so much more.
- More career opportunities closer to home—as the largest healthcare provider in the Baltimore-Washington, D.C. region, there are countless opportunities to grow your career and fulfill your aspirations.
About MedStar Health
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It’s how we treat people.