Processes and enters charge information into database. Completes billing process and distributes billing information. Verifies insurance benefits and assists with referrals. May prepare checks for deposits.
Monitors accounts receivable to maintain appropriate levels and reviews payments to maximize reimbursement. Interacts with patients, insurance carriers, the Billing Department and practice personnel concerning patient accounts. Performs all functions in a courteous and professional manner.
Assures all appropriate licensure, certifications and/or accreditations are secured according to policy to include all credentialing issues related to the service.
1. Coordinates all Insurance Authorizations for the service.
2. Verifies and updates necessary information; enters patient demographics and insurance information into the computer.
3. Review tickets for accuracy and completeness, determine appropriate fees for services rendered, calculate totals, collect appropriate amount from patients, properly record information. Responsible for posting hospital charges or other satellite services. Utilizes correct ICD9, CPT and HCPCS coding methods to determine the proper code for the services rendered.
4. Responsible for cross-checking tickets and correcting all detected errors; notifies physician and patient of corrections. Reconciles daily charge tickets within established guidelines.
5. Processes payments received in person and by mail. Records, totals and prepares monies for deposit according to company procedure.
6. Makes adjustments to patients' account including editing charge entries and entering charge corrections, according to established procedures.
7. May reconcile over-the-counter payments with daily input and makes adjustments as needed.
8. Handles collection efforts for all outstanding accounts including patient calls and sending correspondence. Takes necessary steps to establish acceptable payment schedules or refer appropriate accounts to collection agency.
9. May post over-the-counter payments to accounts (or NSF checks) for outstanding balances, including discounts, adjustments and write-offs.
10. Obtains approval/arrangement of Budget plan booklets as established by policy or practice. Follows up to determine if payment arrangements are being met, contacts patients to resolve problems, responds to correspondence or telephone calls from patients about accounts.
11. Follows up, either by telephone or in writing, with insurance companies and patients regarding the processing of outstanding claims and/or appeals.
12. Reviews all Explanations of Benefits (EOBs) and initiates collection procedures for those with zero payments.
13. Maintains NSF checks to ensure the applicable account is added back to accounts receivable, in accordance with NSF policies and procedures.
14. Generates various reports necessary to manage accounts receivable, including denial reports, insurance follow up reports, NSF reports and month end reports.
15. Communicates information to appropriate personnel. Educates staff on corrections, e.g. front-end entry errors in a positive, constructive manner.
16. Collects and reviews managed care contracts for correct billing and payment terms.
17. Identifies problem accounts and follows through to completion.
18. Reviews EOBs to ensure proper reimbursement of claims and reports any problems, issues or payer trends to supervisor.
19. Reviews credit balance reports for correct recipient of refund.
20. Resolves patient billing complaints and questions, initiates adjustments as necessary.
21. Participates in company sponsored collection forums and other educational activities.
22. Helps fiscal management and other administrative staff in implementing cost effective policies and procedures for all areas including billing, insurance, fee schedules, credit/collections, purchasing, and data processing.
23. Gathers and reports monthly and annual data for fiscal, statistical and planning purposes. Develops and implements revenue enhancement strategies for existing practices.
24. Responsible for assuring all appropriate licensure, certifications and/or accreditations are secured according to policy.
25. Follows the CHRISTUS Provider Network guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).
26. Maintains strict confidentiality.
27. Uses oral and written communication skills to effectively convey ideas in a clear, positive manner that is consistent with the CHRISTUS Mission.
28. Maintains established CHRISTUS Provider Network policies, procedures, objectives, quality assurance, safety, environmental and infection control.
29. Implements job responsibilities in a manner that is consistent with the CHRISTUS Mission and Code of Ethics and supportive of CHRISTUS Provider Network's cultural diversity objectives.
30. Supports and adheres to CPN Service Guarantee.
Our Mission: WHY WE EXIST. To extend the healing ministry of Jesus Christ. Our Core Values: WHAT WE BELIEVE IN.DIGNITY Respect for the worth of every person, recognition and commitment to the value of diverse individuals and perspectives, and special concern for the poor and underserved. INTEGRITY Honesty, justice, and consistency in all relationships. EXCELLENCE High standards of service and per...formance. COMPASSION Service in a spirit of empathy, love, and concern. STEWARDSHIP Wise and just use of talents and resources in a collaborative manner.Our Vision: WHAT WE ARE STRIVING TO DO. CHRISTUS HEALTH, a Catholic health ministry, will be a leader, a partner and an advocate in the creation of innovative health and wellness solutions that improve the lives of individuals and communities so that all may experience God's healing presence and love. Our Name and Symbol:WHO WE ARE. CHRISTUS is Latin for "Christ," and proclaims publicly the core of our mission. OUR NAME choice also recognizes the heritage of our two congregational sponsors, the Sisters of Charity of the Incarnate Word in Houston and San Antonio. Jesus Christ is the Incarnate Word, the Word of God made flesh. It is, therefore, only fitting that it is in another form of His name that our health ministries are called together. OUR SYMBOL Reflects the healing ministry of Jesus Christ - a combination of a medical cross and a religious cross. The flowing banner on the cross is a common symbol of the risen Christ, while the royal purple signifies Christ. The flowing banner also conveys a sense of motion as we move forward into a new era of service to our communities.