The Cash Poster/ Denial Analyst is responsible for accurately posting electronic and manual insurance and patient payments into patient accounts (EPIC OCHIN), reconciling payment EO - Bs and generating cash-related reports. The position performs regular and ad hoc payor research and reporting related to payor denial issues, and recommends processes around the findings and analysis of the research. The Cash Poster/ Denial Analyst possesses a broad understanding of the Explanation of Benefits (EOB... more details
JOB DESCRIPTION:
The Cash Poster/Denial Analyst is responsible for accurately posting electronic and manual insurance and patient payments into patient accounts (EPIC OCHIN), reconciling payment EOBs and generating cash-related reports. The position performs regular and ad hoc payor research and reporting related to payor denial issues, and recommends processes around the findings and analysis of the research. The Cash Poster/Denial Analyst possesses a broad understanding of the Explanation of Benefits (EOB), Remittance Advice, insurance denial communication, payor payment processes, CPT and ICD-10 coding, Medicare and Medicaid edits, and healthcare billing/collections processes. Team members are expected to uphold the health centers and organization’s mission by assuring that patients receive health care that is competent, caring, and meets with a high degree of satisfaction.
AGE/PATIENT POPULATIONS SERVED:
Age of Patient Population Served Neonate (birth – 28 days) Infant (29 days – less than 1 year) Pediatric (1 - 12 yrs.) Adolescent (13-17 yrs.) Adult (18 – 64 yrs.) Geriatric (65 yrs. & older) Nonage Specific Task (N/A) Population Bariatric Patients: BMI greater than 40, or greater than 35 with weight-related comorbidities Patient with exceptional communication needs Patient with developmental delays Patient at the end of life Patient under isolation precautions All Populations
ESSENTIAL DUTIES AND RESPONSIBILITIES
This position will uphold the mission and beliefs of the organization by accurately processing
encounters information and capturing all revenue opportunities following the department’s policies
and procedures. Duties are as follows:
§ Reviews and resolves credit balances.
§ Identifying coordination of benefit issues, contacting patients and assisting in resolving discrepancies.
§ Physician Billing experience.
§ Comply with all regulatory agencies.
§ Handles all telephone inquiries related to overpayments/underpayments.
§ Reviews and resolves third party correspondence and denials pertaining to refunds and credits.
§ Works within specific deadlines.
§ Performs other incidental and related duties as required and assigned.
§ Ensure all claims are submitted with a goal of high accuracy and reimbursed at the proper rate and cash posting is completed.
§ Posts and reconciles daily cash batches into EPIC OCHIN
§ Transfers balances to the appropriate party for additional billing, if required
§ Conducts payment posting and credit balance research, including but not limited to
identifying reasons for credit balance and completing credit balance refund paperwork
§ Creates and disseminates the daily cash forecast spreadsheet
§ Conducts in-depth denial trending, analysis, and reporting
§ Responsible for the processing of all the denials in EPIC OCHIN
§ Oversees patient self-pay, private pay billing, and follow up
§ Works independently and exercises good judgment and discretion
§ Completes miscellaneous financial projects and duties as assigned
PHMC COMPLIANCE RESPONSIBILITIES:
§ Understands and adheres to PHMC compliance standards as they appear in the PHMC: Code of
Conduct, Whistle Blowers, and Conflict of Interest Policies.
§ Keeps abreast of all pertinent federal, state, and PHMC regulations, laws, and policies as they presently exist and as they change or are modified.
§ Comply with HIPAA and Confidentiality Policies and Procedures as they apply to the job.
§ Comply with the Department of Public Health (DPH), The Joint Commission, and other accreditation and regulatory agencies standards.
§ Adhere to all PHMC Policies and Procedures.
§ Knowledge and adherence to Infection Control and Environment of Care Guidelines and Procedures as described in the annual education module.
JOB REQUIREMENTS:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
SKILLS:
§ Expert knowledge of Electronic Medical Records (EHR) including the Practice Management System is required.
§ Advanced knowledge of Microsoft Excel.
§ Strong oral and written communication skills.
§ Ability to foster an environment that nurtures collaboration, teamwork, and mutual respect
§ Knowledge of billing requirements of Medicare, Medicaid, Commercial payers, and government entities.
§ Ability to multi-task in an open environment with strong mindfulness and accuracy
§ Knowledge of Microsoft Excel
§ Excellent communication skills
§ Demonstrate exemplary problem-solving, communication, interpersonal, and conflict-resolution skills.
§ Ability to work effectively as a team member
§ Highly responsible and dependable as well as courteous
§ Exemplary organizational skills and ability to prioritize
§ Unconditional ability to maintain patient confidentiality
EXPERIENCE:
§ Minimum of four (4) years working with billing, collections, cash posting, and denials management or experience in an FQHC or medical and dental setting preferred
§ Computer competency
§ Professional and effective oral and written communication skills
§ Organizational skills: the ability to multi-task and manage priorities; meets critical deadlines
§ Intermediate/Advanced with Microsoft Excel skills
§ Experience with EPIC EHR, Allscripts and TriZetto/Payerpath (Clearinghouses) preferred
§ Effective communication skills
§ Self-motivated and initiator of learning new things relating to the work
§ Must be able to manage multiple projects simultaneously
EDUCATION:
§ Associate degree in finance, or Accounting preferred; experience accepted in lieu of a degree
§ Billing Training Program required.
PHYSICAL DEMANDS:
Position requires standing 2/3 of the time, and walking 2/3 of the time. requires sitting under 1/3 of the time, use of hands to finger, handle, or feel 2/3 of the time, reaching with hands and arms, under 1/3 of the time, stooping, kneeling, crouching, or crawling under 1/3 of the time. talk or hear over 2/3 of the time. The position requires lifting up to 10 lbs. up to 1/3 of the time.
WORK ENVIRONMENT:
Moderate noise (examples: business office with computers and printers, light traffic). Exposure to blood-borne pathogens that require the use of personal protective equipment.
SALARY:
Based on education and experience.
