- Monitor billing and follow-up work queues and worklists. Develop an action plan to ensure that all billable claims and follow-up WIP goals are met by the end of each week.
- Act with delegated authority as a liaison between manager and staff. Expedite assistance for staff with questions or issues and promote revenue collection.
- Analyze workflow and implement process improvement solutions when necessary.
- Provide leadership within the Medicare team and actively participate in other roles within the department.
- Develop detailed knowledge of government programs, regulations, and reimbursement methodologies.
- Represent Manager and PBS to outside payers, agencies and OHSU departments.
- Review all accounts on Medicare high dollar reports to determine if assistance is needed to ensure prompt resolution; coordinate with lead workers as necessary to expedite payment.
- Monitor monthly aging reports to ensure timely primary and secondary billing and coordinate referral processes between teams.
- Perform team account reviews to ensure quality follow-up and collection of accounts.
- Work with team to update and maintain procedures and compile training manuals.
- Monitor CMS and Medicare websites weekly for updates and disseminate program information to Team members and other OHSU departments as appropriate.
- Perform random remittance advice reviews to identify patterns; research and implement corrections/changes as needed, ensure regulatory compliance, and work with third parties as needed to maximize revenue collection.
- Perform periodic internal audits of posted transactions to ensure Cost Report accuracy and maximum cash collection.
- Ensure guidelines are implemented, enforced and updated as appropriate.
- Assist with implementation of regulatory changes. Work with PBS staff, other OHSU departments and third parties as necessary.
- Assist with coordinating responses to Medicare/OIG/RAC audits. Maintain files for retention.
- Support Manager as needed in working with OHSU's Office of Integrity and/or legal department.
- Perform internet research of CMS/Medicare regulations to provide OHSU departments with requested information.
- Perform bi-weekly timekeeping reviews to correct errors before each payroll run. Prepare and maintain team vacation calendar.
- Keep attendance spreadsheets accurate and current in accordance with the PBS Attendance Policy. Maintain confidentiality.
- Attend TRAC meetings. Update team following meetings.
- Review the Weekly Report Set by end of day Monday to ensure accuracy and completeness.
- Attend meetings as requested, schedule team meetings, and prepare agendas for meetings.
- Review and authorize vacation schedules and reallocate work as appropriate.
- CRCS certification required. Positions outside of Hospital Patient Business Services may not require certification.
- EPIC certification in HB Resolute preferred.
- 3 years of recent medical collection and/or billing experience. Work experience must have occurred within 5 years of hire date.
- Experience in hospital billing and/or UB-04 claims.
- Knowledge of and experience in interpreting managed care contracts.
- Four years of general office or secretarial experience; OR
- An Associate's degree or certificate in office occupations or office technology and two years of general office or secretarial experience; OR
- A Bachelor's degree and two years of general office or secretarial experience; OR
- An equivalent combination of training and experience.
- Familiarity with Epic applications
- Experience working with a variety of reimbursement methodologies
- Knowledge and experience with APC's
- Ability to use online coding applications
- Experience with the Medicare program within last 3 years.
- Demonstrated leadership abilities in a team environment
- Extreme confidentiality required
- Ability to work and perform in a high volume environment
- Proficient in Microsoft Office Suite applications in Windows environment
- Internet research experience
- Familiarity with DRG, CPT, HCPCS and ICD-10 coding, familiar with modifiers and their use
- Ability to interpret regulations, policies, laws, rules, contracts, etc.
- Detail oriented, analytical with strong written and oral communication skills
- Flexibility required due to frequently changing regulations
- Ability to work independently with minimal supervision
- Proficient in Microsoft Office Suite applications in Windows environment
- Ability to use multiple system applications
- Detail oriented, analytical with strong written and oral communication skills
- Two raises per year - One at anniversary date and one across the board annual increase
- Healthcare Options - Covered 100% for full-time employees and 88% for dependents, and $25K of term life insurance provided at no cost to the employee
- Two separate above market pension plans to choose from
- Vacation- up to 200 hours per year depending on length of service
- Sick Leave- up to 96 hours per year
- 8 paid holidays per year
- Substantial Tri-met and C-Tran discounts
- Additional Programs including: Tuition Reimbursement and Employee Assistance Program (EAP)
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medicare coordinator - Portland, OR , USA, United States - OHSU
Description
Department OverviewOHSU is Oregon's only public academic health center. We are a system of hospitals and clinics across Oregon and southwest Washington.
We are an institution of higher learning, with schools of medicine, nursing, pharmacy, dentistry and public health - and with a network of campuses and partners throughout Oregon.
We are a national research hub, with thousands of scientists developing lifesaving therapies and deeper understanding. We are a statewide economic engine and Portland's largest employer.And as a public organization, we provide services for the most vulnerable Oregonians, and outreach to improve health in communities across the state.
The Medicare Coordinator (Patient Account Coordinator 1) is responsible for all aspects of the Medicare team operations.Function/Duties of Position
Facilitate and coordinate the daily operation of the Medicare billing and follow-up team.
Includes but is not limited to:
Education:
Job Related Knowledge, Skills and Abilities (Competencies):
Benefits:
Oregon Health & Science University values a diverse and culturally competent workforce.
We are proud of our commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status.
Individuals with diverse backgrounds and those who promote diversity and a culture of inclusion are encouraged to apply. To request reasonable accommodation contact the Affirmative Action and Equal Opportunity Department at or
