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COLLECTIONS: Reviews posted remittance advices from assigned insurance carrier(s) within the timeframe established by department policies and procedures, appropriately following up on and resolving any rejections or other non-payments to ensure accurate posting of balances for reimbursement, deductible, co-pay, co-ins, contractual adjustment, non-covered charges, rejected claims, and any balance-billing to the patient or guarantor as appropriate. INSURANCE BILLING: Keeps self informed of billing policies and requirements of assigned insurance carrier(s) by regularly monitoring list-servs, carrier websites, maintaining open lines of communication with provider representatives, researching problem claims, and other means of staying informed that the assigned carrier(s) makes available.

HOUR

<h2>Overview</h2>Copley Hospital, located in Morrisville/Stowe VT, is in search of a Patient Account Representative - Biller to join our team! The Patient Account Representative functions in a team environment to appropriately resolve patient accounts. The responsibilities encompass all financial aspects of the patient encounter from initial billing through final resolution of the account, while maintaining excellent customer service. The Representative specializing in insurance billing & collections is responsible for accurate and timely billing and collections of insurance claims, conducting all activities in compliance with all applicable State and Federal laws, regulations, and policies governing the provision of health care. This is a Full-Time position (PT available).  Copley Hospital has a variety of shifts available across Full-Time, Part-Time, and Per Diem needs. Please consider applying to discuss how your availability may align. Compensation: $18.50-21/hour. The posted salary range reflects compensation for candidates with limited experience. An offer may vary based on factors such as experience, education, skills, internal equity, and market data.  An offer of employment may be outside of the posted range based on those factors.<h2>Responsibilities</h2><ul><li>ACCOUNT MANAGEMENT: Extends payment arrangement offers to guarantors in accordance with department policies and procedures.</li><li>INSURANCE BILLING: Submits coded, complete, timely, and clean claims to assigned carrier(s), either electronically or on paper, on a daily basis, with accuracy and in accordance with the policies and procedures of the PFS department and the specific policies and billing guidelines of the insurance carrier. This includes appropriately working claim edits and timely resolution of claim quality issues and follow-up on missing information.</li><li>INSURANCE BILLING: Reviews late charges on a daily basis and takes appropriate action to submit corrected claims, in accordance with department policies and procedures.</li><li>INSURANCE BILLING: Reconciles claim submission index in CPSI (EBOS) to ensure that electronic claims submitted are cleared through the clearinghouse and accepted by the carrier. Follows-up timely on outstanding claim files.</li><li>INSURANCE BILLING: Takes appropriate and timely action on all correspondence related to assigned carrier(s) in accordance with the policies and procedures of the PFS department and the specific policies and billing guidelines of the insurance carrier.</li><li>COLLECTIONS: Reviews posted remittance advices from assigned insurance carrier(s) within the timeframe established by department policies and procedures, appropriately following up on and resolving any rejections or other non-payments to ensure accurate posting of balances for reimbursement, deductible, co-pay, co-ins, contractual adjustment, non-covered charges, rejected claims, and any balance-billing to the patient or guarantor as appropriate. Communicates appropriately with others within the organization to keep them informed of any non-payment or denial applicable to their area of service or responsibility.</li><li>COLLECTIONS: Follows up on outstanding insurance claims on a daily basis using the Billed but Unpaid report, as well as any priority listing of unpaid claims as assigned by the Billing & Collections Manager and or Director of Revenue Cycle.</li><li>CUSTOMER SERVICE: Responds to internal and external account inquiries in a timely manner and with the utmost professionalism and courtesy. This includes actively participating in the main line phone queue throughout the day.</li><li>OTHER RESPONSIBILITIES: Timely management of documentation in the office in accordance with department policies and procedures (ie. filing, scanning, etc.), and in compliance with privacy requirements of HIPAA, to promote an efficient work flow, ready access to necessary documents by all of the appropriate parties, and the protection of private health information.</li><li>COLLECTIONS: Reviews credit balance accounts at least weekly to identify potential overpayments and submit timely requests for recoupment or refund, in accordance with the requirements of the assigned carrier(s) and department policies and procedures. Prepares credit balance reporting timely, as required by the assigned carrier if applicable.</li><li>COLLECTIONS: Works collaboratively with others in the organization to appeal non-payments or denials of claims for services, as appropriate, and in accordance with the requirements of the assigned carrier(s). Communicates outcomes of appeals to the involved parties.</li><li>ACCOUNT MANAGEMENT: Manages insurance claim lines, collect codes, patient profile information, and electronic files in patient accounts in accordance with the policies and procedures of the PFS department and the Patient Access department.</li><li>ACCOUNT MANAGEMENT: Enters appropriate, succinct, and professional notes in patient accounts in a timely manner for ALL communications with, or regarding, patients, guarantors, or insurance carriers.</li><li>OTHER RESPONSIBILITIES: Perform all job duties with the utmost integrity and in compliance with the requirements of the assigned insurance carrier(s)’s policies and all applicable State and Federal laws, regulations, and policies governing the provision of health care. This includes maintaining a current knowledge of applicable laws, regulations, and policies, as well as communicating any known or suspected compliance concerns to the Billing & Collections Manager, Director of Revenue Cycle, and or the Compliance Officer.</li><li>OTHER RESPONSIBILITIES: Keeps the Billing & Collections Manager and or Director of Revenue Cycle informed of issues encountered in common billing edits, rejections or other non-payments, patient complaints, and any other major issues impacting customer service, cash flow, productivity, revenue integrity, or compliance.</li><li>OTHER RESPONSIBILITIES: Other duties as necessary upon the direction of the Billing & Collections Manager and or Director of Revenue Cycle.</li><li>INSURANCE BILLING: Keeps self informed of billing policies and requirements of assigned insurance carrier(s) by regularly monitoring list-servs, carrier websites, maintaining open lines of communication with provider representatives, researching problem claims, and other means of staying informed that the assigned carrier(s) makes available.</li></ul><h2>Qualifications</h2><ul><li>High School Diploma or equivalent.</li><li>Medical Terminology Course desired.</li><li>Desired health care insurance billing experience, or experience in a hospital admitting, registration, business office, or coding function.</li></ul>

Copley Hospital

Patient Account Representative - Billing

Billing

Cash Flow

Claims Management

Co-Payments

Communication Skills

Credit Analysis

Credit and Collections

Customer Support/Service

Equity Securities

Federal Laws and Regulations

Health Insurance

Healthcare

High School Diploma

Hospital

Insurance

Insurance Claims

Medical Billing

Medical Coding

Medical Records

Medical Terminology

Medical Treatment

Past Due Accounts

Policy Development

Procedure Development

Regulations

Regulatory Compliance

Reimbursement

Sales Management

State Laws and Regulations

Team Player

Time Management

Copley Health Systems Jobs

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Candidate must have capacity to see 25-40 patients per day with staff support performing history/refraction/diagnostic testing. We seek an optometrist who works efficiently but cares about patient health, not just refractions.

Optometrists! Offering 250k+ with 3 months off in the summers (June-Aug). Must be efficient using the support system we have developed. Candidate must have capacity to see 25-40 patients per day with staff support performing history/refraction/diagnostic testing. Work 6 days per week and make more.Seeking a full time (also possible flex time or part time) optometrist experienced with medical billing and coding. We practice medical and primary care optometry in a small, busy office inside Costco in Colchester, VT. We have OCTA, VF, Daytona. Experience with ExamWriter preferred. We co-manage many patients with a team of OMDs.Paid on 1099 contract although W2 position is negotiable. I will try to improve your current situation through pay and/or autonomous/flexible schedule.We seek an optometrist who works efficiently but cares about patient health, not just refractions.Enjoy the abundant beauty and endless outdoor activities in Vermont! 15 minutes from 100 mile Lake Champlain. Country farms, hunting, fishing, biking, skiing, and much more. Job Posted by ApplicantPro

EyeFellows

Optometrist

Optometry

Patient Care

Primary Care

Talent Acquisition

OTHER

This position is responsible and accountable for coordinating the interdisciplinary process that occurs throughout the continuum of care to ensure care coordination, communication and collaboration with patients, families, providers, ancillary services and community partners in order to achieve goals and maximize positive patient outcomes based upon individual assessments of patients' needs. The Care Management Supervisor is a core member of the hospital care team and leads discharge planning through full partnerships with caregivers, internal and external providers/customers, and patients and their families and communities.

Overview:
Copley Hospital, located in Morrisville/Stowe VT, is in search of a Care Management Supervisor to join our team! The Care Management Supervisor is a core member of the hospital care team and leads discharge planning through full partnerships with caregivers, internal and external providers/customers, and patients and their families and communities. This role contributes to the transformation of the health care system into one that meets the demands for safety, quality, patient-centered and affordable care. This position is responsible and accountable for coordinating the interdisciplinary process that occurs throughout the continuum of care to ensure care coordination, communication and collaboration with patients, families, providers, ancillary services and community partners in order to achieve goals and maximize positive patient outcomes based upon individual assessments of patients' needs. Discharge planning will begin at the time of (and prior) admission, and reassessed during hospitalization. Concurrently intervenes to enhance patient quality outcomes and serves as a patient advocate. This position is Full-Time (PT options available).  Copley Hospital has a variety of shifts available across Full-Time, Part-Time, and Per Diem needs. Please consider applying to discuss how your availability may align. Compensation: $30-35/hour. The posted salary range reflects compensation for candidates with limited experience. An offer may vary based on factors such as experience, education, skills, internal equity, and market data. An offer of employment may be outside of the posted range based on those factors.

Responsibilities:
Discharge Planning<ul><li>Leads the discharge planning process which links the patient-family with the appropriate institutional or community resources post discharge and starts at time of admission or prior to planned hospitalization or surgeries.</li><li>Utilizes Key Elements for Evidenced -Based Discharge Planning:</li><li>Include Patient and Family as full partners in the  Discharge process</li><li>Discuss with Patients and family the five key areas to prevent problems at homes<ul><li>Describes what life at home will be like after discharge</li><li>Review medications</li><li>High light warning signs and problems</li><li>Explain the plan of care including test results</li><li>Make follow- up appointments</li></ul></li><li>Educate patient and family using plain language about the patient’s condition, the discharge process and next steps in the patients care plan.</li><li>Assess how well doctors and nurses explain: diagnosis, condition, and next steps in the patients care to the patents and family using teach back strategies.</li><li>Listens to and honors the patients and families goals, preferences observations and concerns.</li></ul>Supports the Care Management/Utilization Review Roles and Functions<ul><li>Case Management: Serve as a clinical resource. Contribute clinical knowledge and expertise to facilitate the attainment of the agreed upon goals of care.</li><li>Collaborate with insurance companies, Social work, and other hospital departments when patient care needs exceed health benefit coverage limitations to negotiate and provide for patient care needs.</li><li>Patients will be assessed to determine appropriateness of admission, use of observation status, continued hospitalization. and placed in appropriate level of care. Maintain knowledge of Medicare-Medicaid guidelines and coding specifics. Communicate with physicians to ensure compliance with Guidelines.</li><li>Communicate with third party payers and insurance companies. Provide clinical information, including patient status, plan of care and discharge disposition as requested.</li><li>Utilizes MCG, Intensity of Service, and Severity of Illness criteria to determine eligibility for acute care and observation services.</li><li>Utilization Review: Perform both concurrent and retrospective monitoring and analysis of variations in the processes of care. Identify and recommend opportunities for improvement as appropriate. Collaborate with nursing/MD, Quality Improvement department.</li></ul>

Qualifications:
Education:<ul><li>Associate Degree in Nursing</li></ul>Experience:<ul><li>Minimum of three (3) years relevant clinical experience including demonstrated use of discharge planning, utilization, and quality management skills. Chart reviewing-auditing, and able to extract and analyze data.</li></ul>License and Certification:<ul><li>RN License in Vermont in good standing</li></ul>Skill Requirements:<ul><li>Strong clinical skills, leadership, and computer skills.</li><li>Able to establish and maintain strong working relationships.</li><li>Self-directed, assertive problem-solving.</li><li>Effect assessment and planning skills.</li><li>Effective written and oral communication skills.</li><li>Champions and builds interdisciplinary teams.</li></ul>

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Patient Account Representative - Billing Copley Hospital

Optometrist EyeFellows

Care Management Supervisor Copley Hospital

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