Job description
Winona Health Services
Winona Home Medical - DME
Retail Billing Coordinator
Full-Time (1 FTE) 80 Hours a Pay Period
Day, Hours between 8:00 am - 5:00 pm
Weekends: No
Holidays: No
This position falls under the supervision of the Director of Retail Services and DME Manager and is responsible for the back-end processing of DME insurance claims and monitoring of patient accounts. Duties shall include, but not limited to checking DME insurance coverage for patients, proper electronic insurance submissions, answering inquiries from insurance companies, follow-up of past due and incorrect payment claims, monitoring of payment/adjustments, and identifying credit/refunds on accounts.
Essential Duties & Responsibilities:
- Oversees the insurance claim appeals and audit process, and may assist patients when dealing with coverage and/or benefit structure issues.
- Educates and ensures that all billing staff members follow the policies, practices and procedures of the institution and performs periodic compliance audits and internal risk assessments. Basic knowledge of DME rules and regulations pertaining to order/dispensing requirements, computer entry, and insurance billing will be required.
- Knowledge of DME and EMR software will need to be learned. Other basic office tasks may include supply ordering, invoice coding/filing, bookkeeping, filing, bank deposits, and report generation as deemed necessary.
- Responsible for reviewing all claim denial/rejection reports and researches the reasons for the denial/rejection. Dependent on the findings of the review, may educate and/or instruct staff on proper billing techniques, refer issue to charge services area for review, and/or provide recommendations for eliminating or reducing future denials/rejections.
- Demonstrates a level of accountability to ensure issues impacting integrity and compliance of organization are reported and make recommendations for improvement.
- Ensures that all data errors are reported and documented and maintain records and files of documentation supporting changes.
- Responsible for providing support for any audit processes with insurance denials and/or adjustments of both government and non-government claims. Provide direct support for any audit process or follow up audit as requested which may include a rebill/adjusted/appealed claim.
- Assist in the gathering of all pertinent documentation as requested by payers from medical records and department staff.
- Follow-up of issues from any audits accordingly and files, maintains, distributes logs of these claims for auditing purposes.
- Performs random audits of accounts to ensure bills were submitted as documented and that accounts have the appropriate follow-up. All findings will be communicated to management with recommendations of counseling/coaching/corrective action plans. Provides continuous input, reports and provides feedback for improvement in maximizing collections, reducing denials and improving upon process to prevent billing errors.
- Reviews patient complaints related to billing issues and may serve as patient advocate and help them understand and resolve issues related to coverage, benefit structure, etc.. May also seek out assistance from other WH revenue cycle staff, if appropriate.
- Serves as an advocate and information resource for external resources, clinical managers and Revenue cycle staff in regards to patient account receivables. Supports the overall success of Revenue cycle department by demonstrating flexibility, collaboration and cooperation in a team environment while maintaining a high level of production and service quality.
- Reconciliation of customer accounts for sales and services that require adjustment depending on insurance payer source. Monitoring, generating, and mailing of patient account statements.
- Processes month-end duties such as balancing or reconciling monthly reports, calculating and posting charges and sending statements as appropriate per software system and accounting procedures.
- Performs basic office duties including, bank deposits, invoice coding and filing, and supply ordering.
- Assist customers with DME product slection on sales floor based on medical needs, physician recommendations and home assessment.
- Complete POS sales transactions for product purchases made by walk-in customers.
- Other duties as assigned by manager/director.
Essential Skills and Experience:
- Completion of high school diploma. Secondary education desired.
- 3+ years cusomter service.
- Able to demonstrate knowledge of billing requirements mandated by government agencies.
- Excellent verbal and written communication skills in order to present and explain information to internal and external customers.
- Proficient with MS office (Word, Excel, Outlook) in word processing, spreadsheet software and internet.
Physical Demands:
Combination of sedentary office work and customer interaction on the retail sales floor.
Work Environment:
Work is generally provided indoors. Fast-paced and challenging environment with constantly changing reimbursement rules and regulations. Multi-tasking ability required due to the wide variety of assigned duties. Not unusual to deal with upset customers.
Required Work Schedule:
Typical schedule is Monday – Friday, ranging from 7am to 5pm. May rarely be asked to work outside of normal schedule upon request of supervisor.
Internal Applicant Policy:
It is the policy of Winona Health to work with employees in an equitable fashion regarding promotions, transfers, and position reclassifications.
Any employee wishing to apply for another available position at Winona Health must submit an application for consideration through the internal application portal. Employees requesting to change positions should have successfully completed at least six (6) months in their current position. Employees currently in the formal disciplinary process may be required to meet with the Director of Human Resources to determine eligibility to request transfer. The employee’s past performance, experience, training and qualifications will be considered in transfer/hiring decisions. Consideration for transfer or promotion is not a guarantee of transfer or promotion. Employees may be given a chance to interview for a position when they meet the minimum position qualifications.
Disclaimer:
Winona Health is an equal opportunity employer. Winona Health does not refuse to hire, discharge, or discriminate against a person with respect to tenure, compensation, terms, upgrading, conditions, facilities, or privileges of employment because of race, color, creed, religion, sex, age, national origin, marital status, genetic information, status with regard to public assistance, membership in a local discrimination commission, sexual orientation, disability, veteran status, or any other prohibited basis of discrimination under applicable local, state, or federal law. Winona Health does not tolerate retaliation against any employee, patient/resident, physician, or other individuals pursuing concerns regarding Civil Rights issues. Winona Health adheres to ALL pertinent governmental policies and legislation including the Civil Rights Act of 1964, Title VII, as amended, and the Minnesota Human Rights Act.
Experience
Preferred- 3 year(s): Business office experience
Skills
Preferred- Computer Skills
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