The Credit//Collection Coordinator monitors and maintains Managed Care Accounts Receivables to include timely payments and a denial tracking system to be reported to Manager on a monthly basis. The Credit/Collection Coordinator will play a key role in the payment review team by reviewing claims and payment information to identify potential individual underpayments and underpayment trends. Identified potential underpayments will be analyzed, enabling other team members to accurately and efficiently pursue lost revenue.
RESPONSIBILITIES Demonstrates ability to perform all specified functions within Credit/Collection department and to train new employees and improve skill level of existing staff. Identifies potential underpayment trends through comparison of managed care contracts to actual reimbursement information. Assists with inpatient coverage.
Assists with outpatient coverage. Identifies area of improvement for all staff and develops programs to train and improve qualifications of all staff. Monitors follow up activity on open accounts receivable on all Outpatient Commercial/HMO, Comp and No Fault.
Monitors and researches Managed Care payment discrepancies, denials and any outstanding issues. Organizes monthly Managed Care meetings with Reps. Maintains open communication with third party payers regarding contract issues.
Reports underpayments and underpayment trends to management and payment review team for pursuit and collection. Monitors and maintains Financial Aid Charity Care applications for Inpatient/Outpatient services. Includes application review and written notification within mandated legislation guidelines.
Provides analyses to Manager. Educates other departments and staff of guidelines. Advises/maintains changes mandated by NYS.
Correlates with Manager special projects, i.e. month end bad debt, Charity Care statistics, outpatient exception report. Submission of weekly/monthly electronic files. Qualifies accounts for Collection/Bad Debt status.
Maintains patient/commercial/HMO overpayments and processes refunds according to departmental policy. Makes use of high volume reports to review historical payment information and determine the accuracy of reimbursement. Performs other related duties as assigned.
Assists with special projects (i.e. Medipac). Assists with A/R rebills.
Serves as brand ambassador by upholding the WMCHealth Mission, Vision, and CARE values and promoting excellence in the patient experience, during every encounter. QUALIFICATIONS/REQUIREMENTS EXPERIENCE 3-5 years’ experience in healthcare operations and data. EDUCATION College preferred, High School Diploma required or equivalent.
LICENSES/CERTIFICATIONS N/A OTHER If applicable, the individual performing this job may reasonably anticipate coming into contact with human blood and other potentially infectious materials. Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control. Excellent organizational abilities.
Solid knowledge of all MS Office products. Strong analytical, oral and written communication skills. Ability to analyze and problem solve.
Excellent interpersonal and customer service skills.