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Job Summary
Responsible and accountable for monitoring and/or resolution of high dollar, high profile, escalated accounts, timely and accurate posting, adjustments, correspondence, and/or denials resulting in significant exposure to Prisma Health.
Work accounts ensuring complete, accurate, and compliant processes resulting in optimal collection and customer service performance for the organization.
Work on various special projects as assigned to ensure billing, AR and denial prevention is optimal.
Knowledge of payers and provides support to other team members as needed.
Meets and exceeds the appropriate performance and productivity standards and key performance indications for the department.
Demonstrates accurate and professional relationships with all Prisma Health patient accounts, ancillary departments and third party payers in accordance with Prisma Health Service Excellence, Standard of Behaviors and Compliance.
Accountabilities
Monitors, researches and/or resolves high dollar, high profile, and problem accounts, providing necessary information to various internal revenue cycle departments, clinical and corporate departments, and patients for resolution of account inquiries.
25%
Monitors, reviews and provides analysis of all assigned work queues, dashboards and watch lists, payer communications and analysis, identifying trends and working with other departments to resolve system issues.
15%
Demonstrates superior communication skills necessary for developing and maintaining positive professional relationships with team members, revenue cycle departments, clinical and corporate departments, payers, and industry organizations.
15%
Evaluates payer performance and payment trends to provide management with valuable statistics to facilitate improved payer relations and contracting criteria, identifies payer specific problem trends and works with clinical departments, outcomes management, managed care, reimbursement and PFS to rectify systematic issues.
10%
Facilitates, attends and/or participates in payer assigned meetings for improved payer relations and to identify and resolve payer processing, claims and denial issues.
Assures timely communication of all meeting outcomes to appropriate PFS team members.
10%
Attends appropriate meetings and training seminars to assure awareness and understanding of all billing regulations, compliance policies, industry changes, and/or payer reimbursement guidelines.
Maintains professional growth and development through seminars, workshops, in-service meetings, current literature and professional affiliations to keep abreast of latest trends in field of expertise.
5%
Recommends and assists in the development of regular training sessions with team members, to ensure highest quality and productivity standards are achievable.
Assists in on boarding of new team members as well as providing ongoing support for all FS team members.
5%
Identifies payer specific trends and works with revenue cycle, clinical and corporate departments, managed care and reimbursement teams on resolution.
5%
Maintains strict adherence to department quality measures and timely and accurate completion of assigned responsibilities.
5%
Responsible and accountable for reconciliation and accuracy of vendor invoices, vendor staff set up in EPIC, vendor collection and expense reports.
5%
Supervisory/Management Responsibilities
This is a non-management job that will report to a supervisor, manager, director or executive.
Minimum Requirements
High School diploma or equivalent OR post high school diploma / highest degree earned
5 years - Health Care Revenue Cycle experience including registration, billing, collections, credits, refunds, customer service, banking, finance or managed care.
Knowledge, Skills or Abilities
CRCA or CRCR - preferred
Work Shift
Day (United States of America)
Location
1200 Colonial Life Blvd
Facility
7001 Corporate
Department
70019935 System Billing Office
Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve.
The transformation of healthcare requires talented individuals in every role here at Prisma Health.
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