Reimbursement Specialist- Homecare Finance - Nationwide Children's Hospital - Columbus, OH

Reimbursement Specialist- Homecare Finance - Nationwide Children's Hospital - Columbus, OH -

Come work for a corporation the place all the things issues.

Short-term place, three+ months
Schedule: eight-5, Monday – Friday
40 hours per week

Abstract:
Coordinates affected person accounts from time of prior authorization to level of invoice cost or referral to assortment. Processes all billing for residence well being company to applicable businesses, together with Medicaid and self-pay; computes contractual changes, maintains associated information and data. Maintains present information of modifications in billing necessities and laws. Assists shopper in resolving billing issues.

Obligations:
1. Evaluations insurance/main payor info for completeness.
2. Collects and paperwork ongoing payer supply info.
three. Verifies prior authorization necessities from the private and non-private insurers.
four. Obtains preliminary and ongoing prior authorizations for all service strains in response to payor particular necessities.
5. Performs knowledge entry of preliminary and ongoing affected person info and authorizations inside acceptable timeframe in response to NCHH coverage and procedures.
6. Critiques statements and claims for reasonability and completeness. Identifies and obtains needed further info. Rebills accounts when needed. Identifies billing issues and recommends options to the NCHH Finance Supervisor and household as applicable.
7. Prints, posts, and processes all affected person payments, correlating the required documentation for submission of payments for reimbursement in a well timed method.
eight. Posts funds to accounts upon receipt.
9. Generates all billing, money receipts, write-offs and associated studies for month-to-month accounting evaluation.
10. Supplies comply with-up rejection/denials/unpaid payments in a well timed method.
11. Screens accounts. Processes refunds, refiles and corrects accounts, identifies and resolves billing issues, consults with representatives from reimbursement businesses.
12. Notifies NCHH Finance Supervisor of inquiries/complaints pertaining to affected person accounts from sufferers, insurance corporations, assortment businesses, authorized representatives and NCH providers.
13. Maintains present information of modifications in billing necessities and laws; screens modifications in Medicaid, BCMH and Medicare laws and billing necessities; information process updates; and revises billing procedures.
14. Verifies prior authorizations previous to the billing for NCHH providers.
15. Payments and prepares ledger sheets for ODH Waiver Program billing.
16. Maximizes reimbursement by means of verbal and written communications, schooling and counseling of households, skilled suppliers, case managers, and residential care personnel.
17. Follows NCHH assortment procedures for account comply with-up for all unpaid claims.
18. Assists, as applicable, in complying with relevant: federal, state and native legal guidelines; Medicare / Medicaid Circumstances of Participation; JCAHO requirements; State of Ohio Waiver laws; and another applicable accrediting or regulatory physique.
19. Participates as directed in marketing efforts and group endeavors.
20. Participates in drills (together with hearth, bomb, twister, climate catastrophe, group catastrophe, and so on.) and ICES Rounds and comply with up, as directed, to make sure the security of sufferers, households, employees, college students, distributors, guests to the NCHH constructing, and so forth.
21. Promotes, fashions and participates in NCH and NCHH customer support initiatives; fosters affected person / mum or dad / caregiver, payor, supplier and different group relationships via utilizing efficient communication and collaboration expertise; and brazenly and willingly supplies NCH employees and managers with buyer suggestions, in an applicable and aim-oriented approach.
22. Actively participates in NCHH steady high quality and efficiency enchancment actions beneath the path of the QI Coordinator and respective supervisor(s) (together with occasion monitoring and reporting, affected person case conferences, efficiency enchancment groups, buyer satisfaction surveys, utilization assessment actions, and so forth.)
23. Conducts self in a fashion that helps good affected person relations and tasks knowledgeable picture in line with NCH and NCHH requirements.
24. Maintains always the rights of the affected person / household relating to confidentiality of the medical document, in accordance with coverage.
25. Helps the philosophy, mission, insurance policies, procedures, requirements, and strategic objectives of NCH and NCHH; participates, as directed, briefly and lengthy-vary planning and NCHH strategic aim improvement, implementation and analysis.
26. Manages personal studying and expertise associated to present and new pc techniques, as applicable, together with turning into proficient in NT / Outlook and Microsoft Workplace 2010.
27. Participates basically and division employees conferences, committee work and different associated actions as assigned.
28. Performs different duties as assigned, together with the idea of latest duties commensurate with the expansion of the company.

Different info:
KNOWLEDGE , SKILLS AND ABILITIES REQUIRED

1. Minimal two years’ expertise billing private and non-private insurers for medical providers utilizing computerized billing system required, with expertise associated to Homecare providers most popular.
2. Information of and former expertise utilizing Microsoft Excel, Phrase, and skill to function 10-key including machine required.
three. Excessive Faculty diploma required.

MINIMUM PHYSICAL REQUIREMENTS

Sitting Ceaselessly (34 – 66%)
Speaking on the telephone / in individual Ceaselessly (34 – 66%)
Typing on a keyboard Ceaselessly (34 – 66%)
Standing / strolling Sometimes (00 – 33%)
Lifts objects weighing as much as 30 kilos Sometimes (00 – 33%)

The above listing of duties is meant to explain the overall nature and degree of labor carried out by people assigned to this classification. It isn’t to be construed as an exhaustive listing of duties carried out by the person so categorized, neither is it meant to restrict or modify the proper of any supervisor to assign, direct, and management the work of staff underneath his/her supervision.

EOE M/F/Incapacity/Vet

US: OH: Columbus

EOE/M/F/Incapacity/Vet

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