This is a position for MA after Medicare, billing and collection involving rules and regs related to Medicare Bad Debt
The Accounts Receivable Specialist I is responsible for the billing and collection of the accounts receivable for either St. Luke’s Hospital services and/or the professional-fee billing for physician and advanced practitioner services for the St. Luke’s Physician Group. The Accounts Receivable Specialist I is responsible for accurate and timely submission of claims to third-party payers, intermediaries and guarantors in accordance with network policy.
JOB DUTIES AND RESPONSIBILITIES:
Process all UB04 and HCFA-1500 claims through the related billing system, working the related claims scrubber in a timely and efficient manner; performs all associated duties in order to ensure the completeness and accuracy of all claim information, facilitating maximum reimbursement.
Performs duties as scheduled, prioritizing as required to ensure claims are submitted timely, and maximize cash flow is received.
Verifies accuracy of billing data and makes revisions as need be.
Identifies and reports any claim submission issue trends to Management team.
Obtains and maintains a basic understanding of third party billing requirements as assigned, including federal, state and commercial payers.
Responsible for account receivable, investigates and reviews claims based on the productivity standards set by management.
Analyze daily aging of insurance accounts via the billing system to determine appropriate follow up for non- payment and delayed payment accounts, as well as to ensure compliance with all Federal, state, insurance payer and St. Luke’s Network policies.
Analyzes denied claims and investigates the reasons causing the denial and takes the necessary action to resolve the denial and/or resolution of the account.
Seeks resolution to problematic accounts and payment discrepancies with optimal goal of receiving accurate payments and maximum reimbursement.
Statuses claims resolution, appeals and corrected claims via payer websites when possible.
PHYSICAL AND SENSORY REQUIREMENTS:
Sitting up to 8 hours per day, 4 hours at a time. Continuously fingering and handling for data entry, typing, etc… and occasional twisting and turning. Uses upper extremities for occasional lifting and carrying up to 10 lbs. Frequently stoops, bends, or reaches above shoulder level to retrieve files. Hearing as it relates to normal conversation and telephone. Seeing as it relates to general vision. Visual monotony when reading reports and reviewing computer screens.
EDUCATION:
High School Diploma or equivalent. Medical Billing/Coding Program certificate preferred. Must be able to speak, read and write English. Must possess strong verbal and written communication skills.
TRAINING AND EXPERIENCE:
Experience with third party billing in a hospital similar medical facility or physician’s office is preferred. Direct experience is required with Microsoft Office Suite and web navigation and /or web based applications.
Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!
St. Luke's University Health Network is a regional network of hospitals, physicians and other related organizations providing care primarily in Lehigh, Northampton, Monroe, Carbon, Schuylkill, Bucks, Montgomery and Berks counties in Pennsylvania and Warren County in New Jersey.
The Network provides services at more than 150 sites. St. Luke's University Health Network is comprised of six hospital sites. The Network includes:
Areas of exceptional medical expertise include:
St. Luke's offers an exceptional benefit plan for employees. Our values are reflected in all we do for patients, each other and the community:
Pride - We take pride in our accomplishments and in our organization.
Caring - We show consideration for others and their feelings. We treat others as we want to be treated.
Respect - We recognize the value, diversity and importance of each other, those we serve and the organization.
Accountability - We are responsible to make decisions and solve problems in a timely and effective manner.
Flexibility - We adapt to the changing needs and expectations of those we serve.
Teamwork - We work together to improve quality.
The mission of St. Luke's University Health Network is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.