Summary: This position provides support specific to Revenue Cycle Management components, inclusive of client registration, service tracking, insurance verification, denial management and data management. Individual accountabilities and work volume will be established through the development of annual Success Objectives, within the framework outlined below.
Essential Duties and Responsibilities:
Tracks and maintains State (DMH/DASA) and Managed Care service data specific to registration/billing requirements to assure that claims are generated within deadlines and meeting various compliance standards
Performs moderate to high volume of data entry into organization information systems..
Assures accuracy and completeness of databases and returns data forms, which are incomplete or inaccurate.
- Conducts quality assurance activities to insure accuracy of program participant data
- Coordinates patient registration activities with service programs.
- Maintains a strong familiarity with service codes relevant to service claims
- Coordinates with care team(s) to improve collaboration in processing in areas that impact revenue cycle management
- Maintains/tracks contact with third party agencies (including) Managed Care Organizations as it relates to revenue cycle management
- Develops and maintains relationships with internal departments, organization-wide contacts and external contacts in order to meet department goals and objectives.
- Maintains thorough understanding of medical coverage and third party liabilities, inclusive of Medicaid, Medicare. Verifies and updates third party insurance.
Assures compliance (internal/external) for various requirements: Rule 132, Rule 2060 HITECH, HIPAA, 42 CFR Part 2, CARF, Managed Care Organizations, etc.
Assists with the coordination of pre-authorization process for behavioral health programs including Rule 132 services, FQHC and DASA
Supports service reconciliation specific to Revenue Cycle Management activity.
- Participates and contributes actively in regular supervisory and team/unit meetings, in-house training sessions, conferences, seminars and independent study. Participates in program and operational planning.
- Acts as a second round back up to the CIS system including assistance with Help Desk tickets, account set up, troubleshooting and basic training as needed.
- Generates and distributes monthly management and ad hoc reports from CIS and relevant BH systems.
- Supports service reconciliation specific to Revenue Cycle Management activity.
- Assists with developing and updating workflows as it applies to role and program specific.
Performs other job related duties as assigned
Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience: High School Diploma and seven years of related experience or Associates degree and one year of related experience. Prior experience in a healthcare related field or social service agency preferred.
- Certificates, Licenses, Registrations: Certificate in medical billing, medical office assistant, or a related field preferred.
- Competencies: Ability to use computers to tabulate and analyze data and electronic technology to receive, organize, prioritize, and transmit information. Comprehension of and appropriate use of medical terminology, new developments in the health care delivery system, application of third party payer guidelines and concepts related to quality assurance measures. Ability to implement organization policies and procedures and maintain compliance with established risk management and safety procedures. General knowledge of medical record keeping and accounting, medical office practices, patient relations, and medical law, ethics and federal and state health care regulations.
- Computer Skills: To perform this job successfully, an individual should have experience with Medical Practice Management System/s and be willing to acquire knowledge of Centricity Practice Solution/EHRS; CIS, Microsoft Office; Internet Explorer; and other related online systems & tools
- Reasoning Ability: Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
- Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
- Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
- Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
- Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
- Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; Supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity.
- Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
- Motivation - Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles; Measures self against standard of excellence; Takes calculated risks to accomplish goals.
- Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks; Develops realistic action plans.
- Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
- Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures.
- Technical Skills - Assesses own strengths and weaknesses; Pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others.
- Demonstrates organizational values and models leadership behaviors; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
- Project Management - Develops project plans; Coordinates projects; Communicates changes and progress; Completes projects on time and budget; Manages project team activities.
- Innovation - Displays original thinking and creativity; Meets challenges with resourcefulness; Generates suggestions for improving work; Develops innovative approaches and ideas; Presents ideas and information in a manner that gets others' attention.
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel and talk or hear.
The employee is frequently required to reach with hands and arms.
The employee is occasionally required to stand; walk; sit; climb or balance; and stoop, kneel, crouch, or crawl.
The employee must occasionally lift and/or move up to 15 pounds.
Heartland Alliance makes all hiring and employment decisions without regard to race, creed, color, age, gender, gender identity, marital or parental status, religion, ancestry, national origin, physical or mental disability, sexual orientation, sexual identity, immigrant status, political affiliation or belief, ex-offender status (depending on the offense and position to be filled), unfavorable military discharge, membership in an organization whose primary purpose is the protection of civil rights or improvement of living conditions and human relations, height, weight, or HIV infection, in accord with the Organization's AIDS Policy Statement of September, 1987. Individuals with disabilities requiring accommodation should contact the Employee Services Office at (312) 660-1431.