Senior Payment Reviewer

Position Summary

Reviews all remittance advice to ensure appropriate reimbursement for 3rd party accounts billed. Reviews HMO/Insurance contract matrix and HIS expected reimbursement amounts to ensure reimbursement is appropriate. Maintains systems contract proration, audits accounts to ensure accuracy. Responsible for upkeep of contract matrix and proration management. Evaluate and education payment team on performance. Responsible for training on contracts and staff responsibilities.

Essential Functions And Responsibilities Includes The Following

• Understands and adheres to the WPH Performance Standards, Policies and Behaviors.
• Reviews 3 rd party remittance advice to ensure proper payment was received from insurance carrier based on contract arrangement.
• Reviews HIS to ensure expected reimbursement amount is amount received by insurance carrier.
• Contacts insurance plans and provider representatives regarding any reimbursement discrepancies.
• Research and initiate refunds to patients or insurance carriers as needed.
• Sends inquiries to patients regarding inaccurate or incomplete information.
• Completes charge adjustments and allowances entries on accounts as needed.
• Recodes accounts by insurance carrier and plan number and enters into the HIS for-re-billing purposes.
• Processes rejections on accounts denied by insurance carriers.
• Assists with telephone calls as needed.
• Responsible for upkeep and maintenance of HIS proration.
• Responsible for training of staff and staff performance audits.
• Assist management in staff evaluation, performance review and reports as assigned.
• Upkeep of contract matrix for the facility.
• Assists with telephone calls as needed.
• HBI certification certificate required prior to end of probationary period.
• Performs all other related duties as assigned.
  
  

Education & Experience Requirements

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• High School Diploma or GED required.
  
  

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• Clerical experience required
  
  

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• Previous hospital experience and contract review experience required
  
  

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• Ability to use basic office equipment and knowledge of CTR computer terminals required
  
  

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• Medical terminology helpful but not mandatory
  
  

Core Competencies

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• Ability to cooperate with others.
  
  

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• Must be able to speak, write understand and communicate the English language.
  
  

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• Effectively communicate with internal and external customers.
  
  

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• Integrity to handle the confidential aspects of work
  
  

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• Retains composure under stress.
  
  

Physical/Mental Demands/Requirements & Work Environment

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• May be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may be exposed to are listed in the hospital’s SDS (Safety Data Sheet) data base and may be accessed through the hospital’s Intranet site (Employee Tools/SDS Access). A copy of the SDS data base can also be found at the hospital switchboard, saved on a disc.
  
  

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• Must be able to remain in stationary position 50% of the time.
  
  

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• The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc.
  
  

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• The person in this position frequently communicates with insurance plans, must be able to exchange accurate information in these situations.
  
  

Primary Population Served Check Appropriate Box(s) Below

☐Neonatal (birth – 28 days) ☐Patients with exceptional communication needs ☐Infant (29 days – less than 1 year) ☐Patients with developmental delays ☐Pediatric (1 – 12 years) ☐Patients at end of life ☐Adolescent (13 – 17 years) ☐Patients under isolation precautions ☐Adult (18 – 64 years) ☐Patients with cultural needs ☐Geriatric (> 65 years) ☒All populations ☐Bariatric Patients with weight related comorbidities ☐ Non-patient care population

The responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of White Plains Hospital.