Medical Billing - Patient Advocate
Houston
Job Description Job Description Description:
The Patient Advocate is responsible for effectively managing the billing cycle for assigned client site(s) by working the 4 C’s: Charges, Claims, Cash, and Collections to achieve Gold Standard Results. Accountable for reviewing charges for accuracy, submitting clean claims, posting and reconciling payments, and resolving insurance and patient accounts receivables to payment resolution. The Patient Advocate must be able to handle multiple, simultaneous tasks effectively and efficiently and is expected to demonstrate ENCORE in all communications.
Key Skills
Excellent verbal and written communication
Problem Solving
Customer service focused
Relationship building
Self-motivated
Strong organization skills
Adaptability and willingness to remain flexible when changes occur
ENCORE
E ncourage others’ success
N ew ideas; anticipate problems
C reate financial value for our clients
O wnership towards a solution
R each Life Balance
E mbody a positive approach
Vitals for Success
Understands insurance terminology, including deductibles, out-of-pocket coinsurance, copayments, and in-network and out-of-network.
Perform daily review of charges queued to go out to third party payers for clean claim submission.
Post incoming insurance and patient payments daily and ensure payments reconcile to client(s)
Manage A/R by working denials and delinquent insurance balances
Evaluate, prioritize, and perform A/R follow-up work through phone calls, appeals, claim corrections and re-files as needed to resolve A/R balances
Document accurate collection activity for reporting and tracking
Knowledge of insurance plans and patient payment options available
Understands how to read the patient’s ledger and correct reassignment of coinsurance, co-payments, and deductibles to the patient.
Answer incoming calls on or before the third ring
Follows patient balance protocol and provides support with patient questions, and requests and assists patients with creating payment plans and/or taking credit card payments
Gather, analyze, and communicate monthly accounting summaries and closing reports for management and client review and communicate to client in a timely manner
Familiarity with RBS Revenue Cycle Structure - Clients and Physicians
Stays current on training processes and developments within the company
Reviews processes and provides suggestions for process improvements and efficiencies
Learn radiation oncology-specific CPT codes, terminology, payer trends and billing requirements
Perform additional duties as assigned by management
Exhibit ENCORE values
Vital Metrics
Interacts with physicians, medical office personnel, and patients to ensure the A/R cycle is completed in an accurate and timely manner
Charges are filed within 3 days of charge receipt
ERA payments should account for at least 95% of total insurance payments to reduce manual posting work
DSO goal is less than 35 days
Aging goal for A/R over 90 days is below 15% of total A/R for assigned client(s)
Collections A/R follow-up accounts for 33% of workload
Meet monthly goal of defined number of patient interactions
Meets defined monthly number of client engagement and/or interactions
Physical Demands
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Ability to lift/carry up to 25 pounds. Ability to sit/stand for long periods of time. Good manual dexterity with the ability to perform repetitive hand/wrist motions. Ability to manage multiple tasks as assigned and handle stressful situations.
Works in typical office environment. The noise level is usually moderate. May require travel at times to either client sites or RBS office locations. Requires mastery of complex language, comprehension, reasoning, and analytical skills typically found in mid to high-level work.
Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education/Experience
High School Diploma
One or more years of healthcare billing experience, preferred.
Excellent communication skills (strong spelling, proofreading, and grammar skills)
Knowledge of Microsoft Office products (Word, Excel, Outlook)
Other Expectations/Skills
A servant-minded approach to assisting patients, clients, colleagues, and management.
Experience with computerized practice management/billing systems and software
Knowledge of ICD10, CPT, and HCPCS Codes, preferred.
Knowledge of medical business office procedures and medical terminology, preferred.