Job Description

University of Utah Job Description

Job Summary

Reviews Explanation of Benefits (EOBs), incoming insurance checks, and remittance advice received from payors to ensure accurate distribution and posting of payments to accounts. Audits to ensure that bills are correct and all required billing documents are available. Performs account maintenance and follow-up.

Qualifications

Two years of accounting or medical insurance claim experience or equivalency (one year of education can be substituted for two years of related work experience); a basic understanding of debits and credits, word processing, spreadsheet, and ten-key by touch skills, strong analytical skills, and effective verbal and written communication and human relation skills required.

Familiarity with commercial or government billing requirements and knowledge of insurance, coding, and medical terminology is preferred.

This position is patient-sensitive and must fulfill all associated vaccination requirements, or be approved for an exemption, prior to the first day of work. We protect our patients, coworkers and community by requiring all patient-sensitive employees to be immunized according to CDC standards and hospital policy. Limited exemptions may be made for documented medical contraindications or religious beliefs that object to vaccinations.

Applicants must demonstrate the potential ability to perform the essential functions of the job as outlined in the position description.

Disclaimer

This job description has been designed to indicate the general nature and level of work performed by employees within this classification.  It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to the job.

Essential Functions

1. Processes EOBs by referencing date of service, amount billed, amount paid, and any associated contractual or patient responsibility. Annotates each account with information from EOB.
2. Researches incoming checks and remittance advice and ensures accurate distribution and posting of payments.
3. Prepares bills for various payors, verifying that patient information, dates of services, and coding are correct; coordinates with Health Information Department to resolve coding discrepancies and correct them in billing system.
4. Ensures accurate transmission of all electronic and/or manual claims. Monitors electronic posting processes for accuracy and retrieves files and corrects errors when necessary. Balances electronic remittances with patient accounting financial system.
5. Researches and prepares patient/insurance refunds according to hospital policy. Verifies patient eligibility for refund by referring to EOBs.
6. Computes contractual or other adjustments based on explanation of benefits, remittance advice, and insurance contracts.
7. Resolves payments posted to unapplied accounts.
8. Batches manual adjustments and payment transfer requests.
9. Prepares self-pay documents, denials, and other documents for data entry.
10. Communicates directly with patients/guarantors and/or insurance companies to verify correct data and benefits. May assist in determining or verifying patient eligibility and benefits, complete admission/registration accounts to reflect correct billing and demographic information, or accept cash and credit card payments from patients.
11. May coordinate with clinical departments to resolve billing issues or obtain additional claim information.

Problem Solving

Insurance Account Representatives follow Hospital, insurance, and Medicare policies and procedures. Within the framework of policy, the incumbent may decide which account balances are correct, which accounts should be written off up to a specified dollar limit, which payments are correctly posted, and which payments need to be reversed.

Challenges encountered include obtaining correct information on patient accounts, verifying patient information, and using appropriate channels to ensure timely receipt of payments. The incumbent must ensure that billing requirements, transaction codes, adjustments, and charges are correct, and maintain current knowledge of billing and insurance requirements that vary from payor to payor. The Insurance Account Representative must accurately process a high volume of payments and ensure frequent deadlines are met.

Comments

Depending on the area of assignment, incumbents may focus efforts on payment posting or billing.

Work Environment and Level of Frequency typically required

Nearly Continuously: Office environment.

Physical Requirements and Level of Frequency that may be required

Nearly Continuously: Sitting, hearing, listening, talking.

Often: Repetitive hand motion (such as typing), walking. 

Seldom: Bending, reaching overhead.

The staff member must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit.  The individual must demonstrate knowledge of the principles of life span growth and development and the ability to assess data regarding the patient's status and provide care as described in the department's policies and procedures manual.