Accounting Clerk (Commercial Claims Follow-up) Full-Time M-F 9AM to 5PM East 42nd Street

Under the supervision of the Patient Financial Supervisor/Manager, performs a variety of patient accounting functions, including but not limited to financial verification, preparation of Medicaid applications, billing, processing accounts, payment and/or charge posting, account resolution, follow-up collections (Third party and patient), correspondence/mail distribution/, vender account reconciliations and customer services questions.

Qualifications

• Education: High School Diploma/GED
• Experience: Excellent communication skills (oral and written)
• The ability to work independently and on a team
• Knowledgeable with the Patient Accounts System(s): Eagle, MEMS, Trac/On-Trac, Cirius, FSS, Cerner, Various Insurance Websites preferred.
• Knowledge of Microsoft Excel and Word (35 WPM min).

Collective bargaining unit: SEIU 1199-MSH

Responsibilities

• Adheres to the Stratified Process Work Environment utilizing either the On-Trac or Trac system applications.
• Analyzes accounts to resolve issues that result in billing and/or payment delays.
• Prepares schedules on work findings, cash postings, global arrangements (splits) and all other schedule that is assigned.
• Prepares all downloads of billing files from Mainframe System to Clearing House. Transmits all clean claims daily to Clearing House and other direct payers.
• Bills and follow-up on specific specialized accounts receivable (bilingual preferred).
• Interviews potential Medicaid patients before admission, during admission and after discharge of admission to obtain essential documentation to process Medicaid application, financial assistance and/or determine the method of hospital reimbursement. Utilize and input into Medicaid Tracking System (MEMS) when preparation of Medicaid application is determined (bilingual preferred).
• Collects form of payment(s) (deposits), for elective, maternity, international, deductible/co-insurance/co-pay and any other patient responsibility. This collection can be prior admission, during admission and/or after admission(bilingual preferred)
• Obtains and validates patient’s third party health insurance. Coordinates and prioritizes insurance within PFS Systems when more than one (1) valid insurance exists. Validation of third party insurance is obtained via various eligibility systems, calls to third party carriers and/or patients ((bilingual preferred)
• Edits unbilled/unprocessed accounts (billing) using PFS HIS Systems, Clearing House Claim Scrubber and/or any payer websites available for claim correction of billed accounts.
• Bill claims to third party payers either electronically or manually.
• Corrects denials and re-bills accounts through PFS Systems.
• Posts all manual charges into the patient accounts system. Inputs appropriate data elements into PFS Systems for specific charge codes (value codes, condition codes, etc).
• Post payments (manual and electronic kick-outs). Post adjustments and reconcile/disposition accounts when necessary.
• Reconcile payments on accounts to ensure that payments agree with negotiated rates. Reviews listings of accounts to ensure payments are received when there are rate changes and/or annual rate increase within said contracts.
• Follow-up all billed third party/self-pay accounts. These accounts are followed up based on parameters set within area of assignment and can be different based on payer. Follow-up action(s) examples can be rebill of account, transfer, assignment of different and/or correction of insurance data, account resolution, phone call, and inquiry through third part website or call to patient. These are just examples and are not limited to these suggestions.
• Distributes and sorts departmental mail received.
• Correspondence is noted on individual patient accounts. Correspondence is worked within PFS Systems based on the parameters set with in the department all other is distributed to appropriate work area.
• Requests Medical Records and communicates correspondence with inter-office departments.
• Sends bills to patients for self-pay balances (bilingual preferred).
• Responds to patient calls or written correspondence regarding billing issues. Proper customer service techniques should be used.
• Scan documents of assignment.
• Reconcile vender accounts. Work payment remittance and closed report/files received by outside venders.
• Perform the preparation of patient and third party refunds.
• Respond to third party audits.
• Account resolution performed on accounts with credit and debit balances.
• Performs other related duties as required.
• Attends Workshops, weekly unit meets and any other meeting assigned.
• Ensures timely completion of required work assignments.