Research Patient accounts related with audits and activity from Third Party Payers and internal audits in accordance with therequired timeframe. Identify and report root cause for all audit recoveries by Third Party Payers and recommends and participate in corrective action plan for Bronxcare Health System/MLK.
ResponsibilitiesContributes to and participates in the Performance/Quality Improvement activities of the assigned department. Contribution and participation includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement (CQI) teams, consistent adherence to the specific rules and regulations of the Bronxcare Health System (a) Safety and Security Policies, (b) Risk Management: Incident and Occurrence Reporting, (c) Infection Control Policies and Procedures and (d) Patient and Customer Service Identifies and reports root causes for Audit recoveries by Third Party Payers and recommend /participate in corrective action for BCHS and MLK. Communicate with all Third Party Payers and internal parties to obtain required information to finish the assignment satisfactorily and within the required time frame.Responsible to ensure compliance regarding billing and timeliness on followup for all assigned accounts received. Utilizes all information systems toretrieve, verify and or appeal denied cases in payer web portal as appropriate Responsible for obtaining medical records for claims that are denied by the payer requesting clinical information. Obtains and submits medical records to the payer, as required. Reviews and obtains UM status and or action recorded
QualificationsThree (3) to Five (5) years’ experience of collection in finance knowledge of Medicare and Medicaid reimbursement processing preferred Experience with the maintenance of the patient file information Experience in billing information systems Experience in a Health Care environment preferred Strong communication skills both verbal and writtenGood analytics skills Ability to multi-task and willingness to learn new skills Ability to deal effectively with multiple information sources
Skills Required
- Three to five years of collection experience
- Knowledge of Medicare and Medicaid reimbursement processing
- Experience maintaining patient file information
- Experience with billing information systems
- Experience in a healthcare environment
- Strong verbal and written communication skills
- Good analytical skills
- Ability to multitask and willingness to learn new skills
- Ability to deal effectively with multiple information sources
What We Do
BronxCare Health System is a voluntary, not-for-profit health and teaching hospital system serving the South and Central Bronx. It operates an 859-bed system with more than 4,500 employees and provides patients access to physicians, appointments, diagnoses, laboratory and test results, prescriptions, and refills through its myBronxCare online service. BronxCare also maintains outpatient services, including its 174th Street Medical Practice.
