Job Description

Vidant Health

About Vidant Health

Vidant Health is a regional health system serving 29 counties in eastern North Carolina. We are working every day to improve the health of the 1.4 million people we serve. Vidant Health is made up of 8 hospitals, physician practices, home health, hospice, wellness centers and other health care services. Vidant Medical Center is affiliated with the Brody School of Medicine at East Carolina University. As a major resource for health services and education, Vidant Health strives to support local medical communities and to work with providers throughout the region to deliver quality care. Our goal is to enhance services that are available locally and to eliminate barriers involving time, distance and lack of awareness that sometimes prevent patients from receiving the care they need.

Position Summary

1. Submit third party payer primary, secondary, tertiary and corrected claims utilizing electronic billing software.

2. Reconcile all confirmation reports post-electronic submission from all third party payers. Evaluate and process the needed corrections and revalidate the claim electronically.

3. Analyze and take appropriate action on payer rejections and denials.

4. Aggressively performs follow-up and collections from the third party payers.

5. Verify payments though manage care payer software for accuracy and aggressively pursue collections on underpayments.

6.Negotiates reimbursement rates with non-contracted third party payers and case managers.

7. Stays current on rules and regulations affecting billing, reimbursement and submission of claims.

8. Process correspondence received from third party payers and patients.

9. Performs other related responsibilities as required or requested.

10. Demonstrates service excellence.

Responsibilities

1. Process claims utilizing billing software containing payer specific edits. Review and resolves errors based on payer regulation and departmental policies including charge reconciliation prior to claim submission. For secondary & tertiary claims, populate applicable fields with the appropriate payment, coinsurance, deductible and reason codes. Submit valid claims daily to the third party payers. Documents all actions taken.

2. Receives daily confirmation reports from post-electronic transmission. Evaluates error reasons, correcting and revalidating claims for resubmission. Makes revisions to mainframe and billing systems and assigns the proper denial reason code for tracking. Documents all actions taken.

3. Review rejections and denials with appropriate actions being taken to correct or appeal. Updates all systems. Documents all actions taken.

4. Pursues collection on accounts not paid in greater than 25 days. Communicates with third party payers and patients in order to expedite payment or account resolution. Documents all actions taken.

5. Review managed care data for over and underpayments. Verifies discrepancy by evaluating and confirming data posted and contract terms. Submit appropriate
documentation to support reconsideration of the claim.

6. Facilitate payment arrangements with non-contracted payers. Determines appropriate reimbursement methodology based on hospital service and term of payment.

7. Reviews payer bulletins and websites for changes in rules and regulations. Interprets and incorporates changes into billing and collection activities. Attends educational seminars and meetings.

8. Responds to all requests for documents required for timely claims adjudication and prompt patient customer service.

9.Performs in accordance with accepted procedure and responds to special requests by management in a timely and accurate manner.

10. Adheres to the policies and procedures. Uses tact and courtesy in all interactions including but not limited to staff, patients and payers. Promotes a positive image and supports management in goals and objectives. Handles inquiries and complaints discreetly and effectively.

Minimum Requirements

High school plus two years of formal training or education in Health Occupations, Business or related or Associate Degree

Two years or more experience in Hospital or Physician Accounts Billing/health information technology/Third party insurance/Patient Accounting/Hospital or Physician Revenue Cycle operations

One year related experience may be substituted for one year of education up to two years

A four year degree in health related field may substitute for 1 year of required experience

Windows based PC skills to include Excel

Other Information

Insurance Department

General Statement

It is the goal of Vidant Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer.   Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.