This is a description of a Staff Position Classification. It is not an announcement of a position opening. To view descriptions of current openings, please go to UNMJobs and Search Postings to view positions that are currently accepting applications.
The following statements are intended to describe, in broad terms, the general functions and responsibility levels characteristic of positions assigned to this classification. They should not be viewed as an exhaustive list of the specific duties and prerequisites applicable to individual positions that have been so classified.
Summary
Under general supervision, performs a variety of complex functions to resolve involved billing problems and issues, and maintains appropriate ledgers. Researches and provides reports on resolved invoices. Performs complex analyses of patient accounts, patient payments, and remittance advices from third party payers; posts complex account adjustment, transfers, and other actions. Initiates correspondence to responsible parties or third party payers, as applicable. Provides day-to-day guidance and mentorship to lower level Patient Accounts Techs, as appropriate.
Duties and Responsibilities
Analyzes and investigates reimbursements from third party payors, such as Medicare, Champus, Medicaid, Salud, HMO's, and other payors, to determine if contracted amount has been allowed; researches and analyzes third party payor remittance documentation to determine pirority of payment and application of adjustments.
Reconciles and applies changes to patient invoices and account to correct account issues; initiates inquiries, either by phone or in writing, to third party payors, and/or patients to resolve reimbursement and credit balance issues.
Responds to requests from third party payors and/or patients regarding reimbursement problems and issues.
Interacts with and advises internal staff regarding billing and documentation policies, procedures, and serves as liaison with other department representatives to resolve reimbursement and/or credit balance issues.
Prepares adjustment and refund request forms.
Collects, analyzes, and summarizes data for preparation of statistical reports; creates and maintains specified data files and logs, maintains computerized systems for collection and tracking of data, and assists in the preparation of reports.
Ensures strict confidentiality of patient medical and financial records, in compliance with federal and state patient privacy legislation.
Assists in departmental problem solving, project planning, and the development and execution of departmental goals and objectives.
May provide task-specific support and guidance to other techs, as appropriate.
Performs miscellaneous job-related duties as assigned.
Minimum Job Requirements
High school diploma or GED; at least 5 years of experience directly related to the duties and responsibilities specified.
Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.
Knowledge, Skills and Abilities Required
Ability to identify and resolve reimbursement and credit balance issues related to all medical insurance payor groups.
Ability to communicate effectively, both orally and in writing.
Ability to utilize an automated accounting system.
Knowledge of state and federal patient privacy of information legislation.
Ability to use independent judgment and to manage and impart confidential information.
Knowledge of rules governing primary/secondary responsibility and patient responsibility after third party payments and denied services.
Knowledge of IDX related screens and functions, to include the various reports currently used to identify and resolve credit balances.
Knowledge of IDX payment and adjustment processes.
Ability to gather, compile and analyze data.
Knowledge of general accounting principles.
Ability to calculate numbers, determine incorrect entries, and post corrections to records.
Knowledge of computer spreadsheet software.
Research, analytical, and critical thinking skills.
Distinguishing Characteristics
Position requires: a) investigation and analysis of reimbursements from third party payers in relation to determine levels and priorities of payments relative to contract provisions; b) reconciliation and adjustment of patient invoices and initiation of inquiries to resolve reimbursement and credit balance issues; c) interaction with and advisement to internal staff in the implementation of policies and procedures and the resolution of complex reimbursement and/or credit balance issues; d) preparation of adjustment and refund request forms; e) analysis of data, maintenance of data systems, files, and logs, and assistance in report preparation.
Working Conditions and Physical Effort
The University of New Mexico provides all training required by OSHA to ensure employee safety.
