We are pleased to welcome Vanessa Coleman, Associate, and Harshita Rathore, Associate, to our Healthcare Law Practice.
On August 8, Managing Member and Healthcare Law Chair John D. Fanburg, along with Member Edward Yun and Associate Harshita Rathore, bylined an article in NJBIZ about a report by the Physician Advocacy Institute in collaboration with Avalere Health which found that from 2019 to 2020, private equity firms and other corporate entities acquired 17,700 practices (a 32% increase) and employed 29,800 physicians.
On August 1, Healthcare Law Members Isabelle Bibet-Kalinyak and John D. Fanburg were recognized by ROI as 2022 Power List Influencer in the Law. Additionally, John D. Fanburg was named in the NJBIZ 2022 Law Power 50 which lists the most influential men and women in New Jersey’s legal profession!
On June 29, NJBIZ recognized Brach Eichler as one of the “2022 Best Places to Work” in the medium-sized (50 – 249 employees) company category in New Jersey. The Best Places to Work program identifies and honors the top 125 companies in New Jersey that benefit the State’s economy, workforce, and fellow businesses. The firm will be honored during an awards dinner and ceremony on September 29.
On July 7, Healthcare Law Member Isabelle Bibet-Kalinyak opined in “How strong are HIPAA protections in a post-Roe world?” about how the fall of Roe v. Wade leaves women at risk of having their personal medical records used by law enforcement.
On June 27, Managing Member and Healthcare Law Chair John D. Fanburg discussed in the New Jersey Law Journal how Brach Eichler managed to outpace the field in terms of growth in 2021.
On June 26, Healthcare Law Member Isabelle Bibet-Kalinyak discussed in Daily Kos how laws limiting abortion have focused on providers, however legal experts say some patients could end up being vulnerable, too.
On June 24, Healthcare Law Member Isabelle Bibet-Kalinyak discussed in Healthcare Dive the ‘chaos’ from state abortion bans going into effect including the legal and criminal implications for providers.
Are you ready to bring your clerical acumen to a health care community that values your work and recognizes it as vital to an overall mission of making life better for others? In addition to your advanced knowledge of multi-payer system and specialty billing procedures and contracts, we’ll rely on you to research incomplete bills, interpret codes and resolve patient complaints. Your desire to communicate with professionalism and patience will reflect the compassionate nature we strive to create throughout the Legacy community.
Edits bills to ensure accuracy and completeness, applying knowledge and understanding of Universal Billing rules, regulations and claim form requirements.
Reviews and completes necessary forms to ensure accurate billing. Specialty contracts and high dollar accounts may require many extra claim forms, knowledge of special requirements, adjustments, and matrix reviews to pay physicians:
Works closely with payors for pre-pricing of high dollar claims to expedite claims processing.
Performs high dollar medical record coding follow-up, contacting HIS to reduce coding delays.
Checks patient demographic and insurance information. May be required to verify insurance for some claims:
Performs verification when billing high dollar accounts.
May check for lifetime reserve days.
Combines inpatient overlap accounts, ancillary outpatient services within 72 hours of an inpatient admit.
Re-assigns claims held in editor to ensure re-routing to appropriate biller.
Follows up for missing information or diagnosis codes.
Ensures proper physician names and provider numbers are listed.
Documents billing history and data for A/R Management.
Submits claims electronically and files hard copy claims as appropriate.
Determines what supporting documents (e.g., Medical Records, Explanations of Benefits, Itemized Bill, TAR forms) should be included with claims and obtains if needed.
Reviews and completes Claim Edits/Daily Unbilled report, taking appropriate action on each claim to reduce billing delays and produce a bill.
Faxes claims to expedite higher volume of payer reimbursement.
Rebills upon request after reviewing account notes and determining action to be taken.
Initiates interim bills, complex in-house claims requiring transaction tracking and involvement in E-chart and/or Cerner Millennium.
May review/resolve accounts with payment discrepancies for Medicare/Medicaid or secondary carriers.
May determine whether “split” bill is required and request proper billing.
May initiate paper adjustments and/or authorizations for agencies requiring special forms.
Understands and applies the proper procedures for writing off adjustments s/he is authorized to make.
May process flag reports ensuring timely verification, rebill, and/or adjustment of claims based upon payer response.
Provides accurate Customer Service to internal and external customers regarding account status and pending actions.
Contacts patients’ families, sometimes in sensitive situations, to resolve billing issues.
Works closely with specialty contract liaisons: hospital attorneys, ASI – collection agency, crime victims, state agencies, Physician offices and/or corporate contracting to ensure proper billing.
Answers all incoming telephone calls, voice mails, e-mails, faxes or personal requests in a professional manner.
Interviews customer and assists appropriately.
Works closely with providers, patients, and members of other LHS departments.
Sets deadlines for future action on accounts.
Communicates with third party payers regarding current account status. Works towards quick resolution and payment of claims. Effectively applies knowledge of regulations and practices used in reimbursement specialty area such as Government, Commercial, Medicare, Medicaid, Workers Comp or Motor Vehicle Accident coverage.
Reviews notes of prior action before calling third party payer for payment resolution.
Calls third party payers to bring claims to payment as soon as possible and remove any barriers that may delay the processing of a claim.
Investigates when claims are suspended, denied, or not expedited.
In account notes, accurately documents action taken and status of claim.
Sends data mailers to patients as appropriate.
Effectively uses appropriate databases to obtain information needed to process claims.
Understands and uses USSP system for accurate claims payment dates and amount of payment and patient balance for all Regence Blue Cross products
Obtains benefits, eligibility, PCP information, and authorization information when necessary to resolve payment issues.
Understands and uses MMIS Online system to determine OHP/Medicaid eligibility and to interpret when OHP is primary or secondary payer.
Understands and uses internet-based payer systems to obtain eligibility authorization, and claim status information.
Understands FSS – Eligibility, claim status, adjustment process.
Reviews and organizes daily follow-up and other critical reports.
Understands and adheres to follow-up Matrix (timeline) for areas of specialty, i.e., number of days until first follow-up, second follow-up, third, etc.
Tracks and reports total number of accounts received weekly.
Groups accounts by payer to minimize number of phone calls needed for follow-up process.
High-dollar, back-logged and call-back accounts are considered priority.
May be responsible for processing certain reports such as Month End, Flag, Daily Unbilled, PARS, Expected Reimbursement, Carrier Code 0414, Carrier Code XX50, or HCFA electronic reports.
Tracks and reports total number of accounts received weekly.
May be assigned to work A/R Reduction reports with responsible area.
Works effectively with large amounts of data and detail. Generates or works from multiple reports which may vary according to payer specialty.
Performs other duties as required.
May serve as Notary Public
May serve as “backup” for other PBS positions.
May process mail.
Acts as key trainer to new departmental employees on team policies/procedures
May be assigned additional duties by leadership
Education:
High school diploma or equivalent.
Experience:
One year of healthcare clerical experience or applicable billing, credit/collections experience. Healthcare billing or credit/collections preferred. Education may be substituted for experience requirement.
Skills:
Demonstrated knowledge high dollar of billing/collection rules and regulations, and specialty billing procedures and contracts.
Demonstrated attention to detail.
Demonstrated knowledge of multi-payor systems.
Knowledge of online systems for eligibility, status review of claims and entering claims manually
Net typing of 40 wpm and PC based computer skills.
Ten key proficiency.
Knowledge of medical terminology.
Ability to work efficiently with minimal supervision, exercising independent judgment within stated guidelines.
Demonstrated effective interpersonal skills which promote cooperation and teamwork.
Ability to withstand varying job pressures and organize/prioritize related job tasks.
Demonstrated effective interpersonal skills which promote cooperation, teamwork, and respect.
Excellent public relations skill and demonstrated ability to communicate in calm, businesslike manner.
Ability to adapt to change.
Demonstrated negotiating, problem-solving and decision-making skills.
LEGACY’S VALUES IN ACTION:
Follows guidelines set forth in Legacy’s Values in Action.
Equal Opportunity Employer/Vet/Disabled
Posting Title: Hospital Billing & Insurance Follow-up Specialist
Job Req #: 22-25217
Name: PBS Hospital Services
FTE for each opening (not total FTE across all openings for multiple openings). If less than 1.0 please enter leading 0 before the decimal, e.g. 0.2: 1.00
Job_Commensurate with Experience: USD $20.22/Hr. - USD $28.90/Hr.
FLSA Status: Non-Exempt
Union: Non-union
Work Days: Mon-Fri, occasional weekends
Shift Start Time (HH:MM AM or PM): 07:00 AM
Shift End Time (HH:MM AM or PM): 3:30 PM
External Company Name: Legacy Health
External Company URL: //www.legacyhealth.org/
Street: 815 NE Davis