This position is responsible for working with a team and supporting management for behavioral health facility and professional charges. Individual is responsible for all revenue cycle processes including but not limited to financial securing, insurance verification, obtaining prior authorizations, claim follow up and denial management.
Contacts and maintains relationships with the payer communities to obtain and verify insurance benefits and eligibility for behavioral health services upon receipt of intake forms or notification of scheduled visits using on-line remotes, eligibility system or by calling directly. Includes group number, billing address, type of contract, employer, co-pay and subscriber information, etc.
At year-end confirms and verifies benefits for existing patients at the start of each new plan Year.
Serves as the liaison for all insurance questions in regards to appropriate plan codes to use and how to correctly update a patients account and resubmission of claims
Works to establish timely, correct payment information prior to the patients service to financially secure the account, promote good customer service, efficient and accurate billing and prompt reimbursement.
Informs providers/schedulers of limited benefits and non-covered services
Discusses benefits with patients 10-14 days in advance of appointment to explain the variation between medical and behavioral health benefits so the patient can make an informed decision as to whether or not to receive treatment.
Communication with providers and clinical staff on a daily basis to advise clinic staff of patients financial obligations co-pays to be collected and necessary waivers to sign upon arrival.
Requests documentation from providers to obtain prior authorization for services.Work complex accounts effectively
Effectively work insurance denials an appeal when necessary with knowledge of payor policies/guidelines
Perform timely claim follow up to ensure reimbursement for services
Works payor correspondence
Introduces new providers to revenue cycle workflows and new initiatives prior to implementation.
Reviews and resolves issues using appropriate resources in resolving outstanding billing issues.
Sets up and monitors patient alerts on accounts to maximize collection efforts related to co-pays, deductibles and outstanding balances due by indicating the appropriate action front desk staff would need to follow to assist with collections.
Responds to phone calls related to patient inquiries related to billing or status of account prior and after service being rendered
Advises patients of out of pocket expenses, insurance limitations and payment options prior to specific services to reduce the patients as well as the organizations financial risk.
Notifies the treating physician regarding patients with high balance accounts to allow the physician to make the determination of whether or not to continue providing services or to refer the patient elsewhere.
Works denials/claim edits daily to ensure reimbursement
Four year degree in health care related field
High School Diploma or GED
One or more years of experience in an office clerical setting (Prefer at least 1 year in a hospital or clinic billing office).
Three ore more years in insurance resolution, patient accounting or medical billing with exposure to medical terminology, financial securing, denials and patient interaction.
Behavioral/Mental Health clinical, insurance claims process or business office knowledge
Knowledge of professional and facility billing including reading payor remittances and payor websites
Other Preferred Qualifications:
Strong skills in the following areas: verbal and interpersonal communication; detail oriented, computer skills (related to Microsoft Office suite of products) and proven ability to interact effectively with staff and management without direct supervision.
Strong conflict resolution skills
Strong critical thinking skills and ability to understand and apply past precedent and other variables to each case
Together with the University of Minnesota and University of Minnesota Physicians we have created M Health Fairview. M Health Fairview is the newly expanded collaboration among the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services. The healthcare system combines the best of academic and community medicine — expanding access to world-class, breakthrough care through our 10 hospitals and 60 clinics.Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Fairview is one of the most comprehensive and geographically accessible systems in the state, with 10 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area.Its broad continuum also includes 60 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider network and health insurer PreferredOne. In partnership with the University of Minnesota, ...Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.