Summary

Performs a variety of routine to complex day-to-day operations that may involve independent research, investigation, and problem resolution, in support of the administration of billing accounts for a defined University medical service or billing agent. May provide task-specific support and guidance to new and/or lower level Account Operations techs, as appropriate.

Duties and Responsibilities

1. Processes and researches electronic data interchange (EDI) reimbursements from various payers; processes EDI payments, contractual allowances, and related transactions on patient invoices, as required.
2. Performs daily and monthly reconciliations to the general ledger, to include reclassifications; receives and balances documents of deposits received, and distributes remittance advices.
3. Researches and analyzes claims from various government and commercial third-party payers; verifies patient eligibility, and adjusts and resubmits claims.
4. Researches and analyzes third-party payer remittance documentation in order to reconcile payments to remittance advices; reconciles and applies changes and corrections to patient invoices and accounts.
5. Follows up directly with third-party payers and/or patients, either by telephone or in writing, to resolve outstanding accounts receivable issues.
6. Ensures strict confidentiality of patient medical and financial records, in compliance with federal and state patient privacy legislation.
7. Interfaces with other department representatives in the resolution of identified problems and issues.
8. Participates in the development and execution of departmental goals and objectives.
9. Collects, analyzes, and summarizes accounts receivable data for problem resolution and effective data management.
10. May provide task-specific support and guidance to other techs, as appropriate.
11. Prepares adjustment and refund request forms.
12. Performs miscellaneous job-related duties as assigned.

Minimum Job Requirements

• High school diploma or GED; at least 3 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

• Demonstrated skill in resolving medical payment issues with third-party payer groups.
• Ability to gather data, compile information, and prepare reports.
• Ability to communicate effectively, both orally and in writing.
• Analytical and problem solving skills.
• Knowledge of medical terminology, ICD-9, and CPT coding.
• Ability to maintain confidentiality of records and information.
• Knowledge of IDX payment and adjustment processes.
• Thorough working knowledge of medical billing, accounts receivable, and payment reconciliation.
• Ability to make administrative and procedural decisions and judgments on sensitive, confidential issues.
• Demonstrated skills in the use of personal computers and medical software.
• Working knowledge of electronic data interchange (EDI) reimbursement procedures and systems.

Distinguishing Characteristics

Position requires: a) researching and processing electronic data interchange transactions, to include EDI payments and contractual allowances; b) research, analysis, and verification of claim variations from third party payers and making adjustments to claims; c) research and analysis of third-party payer remittance documentation; d) direct follow up and resolution of outstanding accounts receivable issues with patients and/or third party payers; e) internal interface and direct assistance in the resolution of identified problems f) collection and summarization of accounts receivable data.

Working Conditions and Physical Effort

• Moderate physical activity. Requires handling of average-weight objects up to 25 pounds or standing and/or walking for more than four (4) hours per day.
• No or very limited exposure to physical risk.
• Work is normally performed in a typical interior/office work environment.

The University of New Mexico provides all training required by OSHA to ensure employee safety.

Revised Date: 03/20/2017