Billing Control Representative FT Days

Description:

DMC Sinai-Grace Hospital is DMC's largest hospital, offering a comprehensive heart center, cancer care, gerontology, emergency medicine, obstetrics/gynecology and cosmetic services. Sinai-Grace's joint replacement program features a revolutionary minimally invasive knee and hip replacement surgery that attracts patients from all over the country. Sinai-Grace operates more than 21 outpatient care sites and ambulatory surgery centers throughout Wayne and Oakland Counties and is one of 10 hospitals in the nation to be awarded a Robert Wood Johnson Foundation grant to help set the standards of cardiac care for hospitals and physicians throughout the nation.

Summary Description

Under the direction of the Manager, Patient Accounting, balances computer reports; reviews all in-patient accounts for compliance to third party payors; reviews and corrects computer-generated error reports; contacts appropriate representative to reconcile insurance coverage (i.e., unverified child on insurance coverage); monitors collection activities of patient account collectors as well as collection agencies; analyzes revenue recovery trends; performs other patient accounting duties assigned.

1. Maintains and updates Information System master files related to Patient Accounting (charge master and billing).
2. Prepares system generated reports, (i.e., daily edit, DRG, etc.), makes corrections and researches irregularities as necessary. Compiles data for presentation.
3. Performs special projects and researches accounts for compliance to third party payors.
4. Monitors payments, reconciles DRG payment discrepancies, processes corrected billing to maximize reimbursement.
5. Prepares and analyses weekly and month end financial reports to monitor activity in specified areas.
6. Maintains statistics on turnover and percentage of recovery by outside agencies and Patient Account Collectors within the department.
7. Performs follow-up activity on pending cases to include medical cases, reconciliation of insurance coverage and other unbilled accounts until completion and billable status is achieved.
8. May maintain information system master files related to Patient Accounting System (e.g., charge master, professional master, insurance master).
9. Monitors bankruptcy cases and notifies appropriate agencies accordingly.
10. Reviews microfiche for legibility and verifies that all reports are accounted for.
11. Promotes the values of the DMC by demonstrating behaviors supportive of a commitment to quality, community welfare, respect and involvement, teamwork, open and effective communication, innovation and education, and efficient and effective resource use.

Qualifications:

Minimum Qualifications

1. High school graduate or equivalent.
2. One to three years of hospital billing or related experience.

Skills Required

1. Must possess firm understanding of accounts receivable, collection and third party payor processes.
2. Knowledge of basic accounting principles.
3. Operational computer skills.
4. Communication skills to interact with payors.
5. Analytical skills and high visual acuity to work on reports.