PURPOSE AND SCOPE :
Supports FMCNAs mission, vision, core values, and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMCNA policy requirements.
Under general supervision of the AR Manager, responsible for billing and collections for patient receivables within the AR Department. Responsible for inbound and outbound calling regarding past due accounts. Makes payment arrangements, secures prompt payment, and resolves billing issues and addresses concern/questions. Informs cash posters on correct application of specific payments or arrangements.
PRINCIPAL DUTIES AND RESPONSIBILITIES: Takes necessary actions to ensure resolution of AR issues and problems for FreseniusRx. Responsible for the collection of $22 million+ in open AR. Interacts with insurance providers, patients, and FMS personnel, as needed, to accomplish collection and correct application of payments received. Executes defined AR processes accordingly in compliance with company policies and procedures, ensuring alignment with business controls and standard operating procedures. Tracks and monitors aging and collection accounts and determines appropriate actions for follow-up. Contacts payers to secure payment on past due accounts or to reach resolution on billing/program issues with a provider/payer. Performs daily review of 3rd party payments, ensuring accuracy at all times. Utilizes critical thinking and analysis to determine account problems and issues requiring follow-up and identifies trends that may negatively impact company revenue. Researches previously submitted unpaid claims to determine cause of non-payment and brings about resolution either by payment or credit if incorrectly billed. Researches denied and underpaid claims and accounts, utilizing contract knowledge to prepare and process formal written appeals to insurance companies. Works with insurance company provider relations representatives to solve coding and contract problems resulting in third party payor underpayments. Processes Medicare denials for re-transmission or for review. Responsible for credit holds and suspension of services due to non-payment. Releases orders on credit hold in accordance to policy and procedure. Generates changes to customer profiles in various billing and provisioning systems to ensure delivery of invoices and billing deliverables. Assists in the review of all requested price changes/billing cycles for accuracy and timeliness, as requested. Provides information and assistance to patients and insurance companies. Performs administrative functions relative to patient and insurance issues. Maintains AR spreadsheets and accounts receivable reports required for management reporting. Reviews 3rd party account status on a regular basis with AR Manager to prevent serious issues from being delayed in resolution. Submits credit and collections documentation to support audit and legal requirements. Requests credit/debit memos and initiates refund requests pursuant to submitted requests and customer disputes. Submits adjustment requests for manager approval and processes approved system adjustments and write-offs as needed on 3rd party payor account balances. Creates and submits documentation when required to do manual submitting of secondary insurance coverage to appropriate organizations in our payor listings. Keeps abreast of organizations and opportunities/requirements within 2nd level coverage payers so to serve the quickest method to assure Fresenius payment as well as taking responsibility for same from the patient. May perform AR Specialist I patient collection and/or AR Specialist II cash posting duties and responsibilities, as needed. May provide assistance to AR Specialist I and/or AR Specialist II with more general support tasks that require a better understanding of AR functions, as directed by AR Manager. Escalates issues to AR Manager for resolution, as deemed necessary. Assist with various projects as assigned by direct supervisor. Review and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations. Other duties as assigned.
Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.
PHYSICAL DEMANDS AND WORKING CONDITIONS: The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Day-to-day work includes desk and personal computer work and interaction with 3rd party businesses, patients, staff, and physicians. The position may require travel between assigned facilities and/or various locations within the community. Travel to regional, Business Unit and Corporate meetings may also be required. The work environment is characteristic of a health care facility with air temperature control and moderate noise levels.
EDUCATION: High School Diploma required; Associates Degree desirable Pharmacy Technician certification beneficial
EXPERIENCE AND REQUIRED SKILLS: 2 4 years experience in Billing and Collections experience, ideally working directly with patients in a Healthcare related field or pharmacy. Excellent customer service and interpersonal skills required. Proficient use of computer and related software such as Microsoft Office (Excel and Word); New Leaf experience a plus. Ability to learn and apply basic skills needed to work with pharmacy systems. Ability to learn pharmacy dispensing regulations and standard medical abbreviations and terminology. Ability to learn and adopt established billing practices and policies. Ability to interpret an extensive variety of technical instructions and convey those to others. Ability to maintain patient confidentiality at all times. Excellent communication skills, both verbal and written. Bilingual ability (Spanish and English) a plus. Dependable, focused, and professional at all times. Detail oriented and able to work under deadlines. Ability to work under general supervision; a self-starter who effectively prioritizes work load to meet established guidelines. Analytical and able to apply proper research and critical thinking to interpret and resolve billing and collection issues.