Healthcare Outcomes Performance Company is a vertically integrated musculoskeletal outcomes management company. HOPCo manages physician practices, hospital service lines, population health and value-based care programs, and musculoskeletal delivery networks.
HOPCo is the managing partner of Arizona-based entities, CORE Institute, Northern Arizona Orthopaedics, CORE Institute Specialty Hospital, Michigan-based CORE Institute, and Florida-based Southeast Orthopedic Specialists.
As HOPCo continues to grow, we are looking for a Payment and Reconciliation Specialist in our Corporate Headquarters.
ESSENTIAL FUNCTIONS:
- Has an understanding of accounts receivable posting process for medical billing including: charges, payments and adjustments.
- Posting financial transactions through use of the automated systems and team processes.
- Accurately interprets insurance explanation of benefits to ensure proper posting.
- Retrieves and uploads 835 remittance files into patient account system ensuring file reconciliation including reviewing and posting exception files.
- Participation in optimizing productivity within area.
- Maintains knowledge of the work area and optimizes use of available technology.
- Researches all information needed to process and complete insurance and/or patient refunds by obtaining information from providers, insurance plans, ancillary services staff and patients.
- Accurately processes insurance and patient refunds requests by demonstrating an advanced understanding of coordination of benefits and eligibility requirements.
- Receives and processes all refunds utilizing insurance contracts and requirements for accuracy.
- Processes and posts refund checks as received into the patient accounting system.
- Establishes and maintains effective communication with physicians, staff and other departments as required.
Other duties as assigned by leadership. - Adheres and understands the Business Office rules and regulations in regards to Medicare and
HIPAA guidelines. - Effectively forwards accounts requiring work up or resubmission to the business office staff.
- Maintains productivity and accuracy metrics per department expectations and AEIOU Behavioral Standards
The job holder must demonstrate current competencies for job position.
EDUCATION:
EXPERIENCE:
- A minimum of two years experience in medical billing and/or cash applications or equivalent experience in a healthcare environment.
- Prefer previous cash posting experience in a multiple lockbox environment.
- Must be able to communicate effectively with Physicians, patients and the public and be capable of establishing good working relationships with both internal and external customers.
KNOWLEDGE:
- Knowledge of revenue cycle processes.
- Knowledge of computer systems. Experience with Centricity patient management system preferred.
- Knowledge of policies and procedures with regards to physician billing processes including determining insurance eligibility and coordination of benefits.
SKILLS:
- Skill in customer service and an understanding of The CORE code of conduct and culture.
- Skill in using computer programs and Microsoft applications.
- Skill in establishing good working relationships with both internal and external customers.
ABILITIES:
- Ability to examine and interpret insurance documents including but not limited to eligibility responses and explanation of benefits (EOB).
- Ability to prepare postings and reconcile daily receipts.
- Ability to communicate clearly and effectively.
- Ability to type minimum 40 wpm.
ENVIRONMENTAL/WORKING CONDITIONS:
- Normal office environment. Some travel within community.
PHYSICAL/MENTAL DEMANDS:
- Requires sitting and standing associated with a normal office environment.
- Some bending and stretching required.
- Manual dexterity using a calculator and computer keyboard.
ORGANIZATIONAL REQUIREMENTS:
- HOPCo Mission, Vision, and Values must be read and signed.
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