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Description

At Cincinnati Children's, we believe in nurturing employees' lives as well as their careers. Our benefits equal or surpass other hospitals in the region, and we're proud to offer one of the best working environments in our field to include opportunities to advance your career within our organization.

Our benefits help you manage your health, protect you if you are unable to work, help you further your education, and prepare for retirement.

At Cincinnati Children's, we believe in nurturing employees' lives as well as their careers. Our benefits equal or surpass other hospitals in the region, and we're proud to offer one of the best working environments in our field to include opportunities to advance your career within our organization.

Our benefits help you manage your health, protect you if you are unable to work, help you further your education, and prepare for retirement.

In this role you will be responsible for:

• Reduce Days in AR and AR over 90 days for Transplant Hospital, Physician and Home Care accounts receivable by working work queues and reports within the assigned portion of the workload through consistent and thorough billing efforts
• Daily review and work errors in account work queues per assigned alpha slit and correct errors in claim edits to ensure timely and accurate claims submission.
• Print claims and prepare transplant bundle packet billing. Ensure all packets are billed timely to insurance.
• Thoroughly document all actions in Epic regarding actions taken on claims and packets submitted.
• Work with Coding Services to correct coding on accounts.
• Work with Clinical Management to ensure transplant claims are billed with appropriate coverage, billing diagnosis, procedure code, etc.
• Complete collector requests for rebills and submit corrected claims in a timely manner.
• Post write offs and adjustments to correct AR at the time of billing. Note system of actions taken.
• Work payer projects assigned by Lead or Supervisor upon request.

SUBFUNCTION DEFINITION: Prepares and forwards patient claims to appropriate third-party payers. Analyzes and reviews claims to ensure that payer-specific billing requirements are met. Follows up on billing, determines and applies appropriate adjustments, answers inquiries and updates accounts as necessary.

REPRESENTATIVE RESPONSIBILITIES

???Billing
Compile and prepare patient charges. Prepare invoices billings, UB-04 and 1500 claim forms to be sent to 3rd party payers for payment indicating individual line items for services and total costs. Review charges. Obtain and evaluate family, third party payers and agency resources for payment of charges. Managing patient billing and ensure procedures are billed according to contracts, transmit or mail all paper and claims, and review correspondence and follow up as needed.

???Financial Support
Obtain and evaluate family, third party payers and agency resources for payment of charges. Counsel patient on third party coverage and present financial aspects. Determine eligibility for State Medicaid, Social Security and other outside funding. Complete necessary paperwork for eligible patients, including medical and financial applications. Coordinate inpatient and outpatient admissions. Coordinate information with the inpatient and outpatient charge systems. Input charges and relative information. Manage accounts receivable data and collection information, ensure timeliness and accuracy. Research third party payers and community physician charges in order to maintain usual and customary as will as competitive charges. Check and update charge master. Conduct utilization review for the division from insurance companies and working in conjunction with Cincinnati Children's Utilization Review department. Process, post, and balance payments to accounts timely, accurately, and in the correct period.

???Systems Support
Maintain and update departmental system, including templates, and payer and physician information.

???Collaboration
Act as a preceptor for new employees. Perform specialty services functions. Act as a resource within the department/division. Provide instruction for performing non-routine functions. Serve as a liaison between Physicians Billing Service, Admitting, Outpatient Surgery, Outpatient Department, Patent Financial Services and other Cincinnati Children's departments.

???Quality
Provide Quality Assurance reports for the division.

Qualifications

EDUCATION/EXPERIENCE

Required:

• High school diploma or equivalent
• 2 years of work experience in a related job discipline.

Preferred:

• F/up experience in a healthcare setting
• Time management
• Ability to prioritize
• Work autonomously

Unique Skills:

• Transplant experience
• Understanding of contracts -being able to read and understand contracts