Job Code/Title: B3021/ Acct Operations Tech 3
FLSA: Non- Exempt
OPEN UNTIL FILLED
UNM Medical Group, Inc. (UNMMG) is the practice plan organization for physicians and other medical providers associated with the UNM Health Sciences Center. UNM Medical Group, Inc. is a New Mexico non-profit corporation and is an equal opportunity employer. UNMMG offers a competitive salary and an attractive benefit package which includes medical, dental, vision, and life insurance as well as tuition assistance, paid leave and 403b retirement for benefits eligible employees.
UNMMG Revenue Cycle Management is the middle and end of UNMMG’s revenue cycle operations. This department is responsible for the managerial oversight of charge capture, charge entry, medical coding and claim submission to third party payers. In addition, the department is responsible for collections, denials, accounts receivable and bad debt management as well as ongoing interface with third party payers related to claims adjudication and payment. Tech 3s are responsible for reviewing and appealing denied claims. They research to determine if a claim was denied correctly, and identify denials trends, and must adhere to the productivity and quality standards set by the department.
The following statements are intended to describe, in broad terms, the general functions and responsibility levels characteristic of positions assigned to this classification. They should not be viewed as an exhaustive list of the specific duties and prerequisites applicable to individual positions that have been so classified.
Under general supervision, performs a variety of complex functions to resolve involved billing problems and issues, and maintains appropriate ledgers. Researches and provides reports on resolved invoices. Performs complex analyses of patient accounts, patient payments, and remittance advices from third party payers; posts complex account adjustment, transfers, and other actions. Initiates correspondence to responsible parties or third party payers, as applicable. Provides day-to-day guidance and mentorship to lower level Patient Accounts Techs, as appropriate.
Duties and Responsibilities
- Analyzes and investigates reimbursements from third party payors, such as Medicare, Champus, Medicaid, Salud, HMO's, and other payors, to determine if contracted amount has been allowed; researches and analyzes third party payor remittance documentation to determine priority of payment and application of adjustments.
- Reconciles and applies changes to patient invoices and account to correct account issues; initiates inquiries, either by phone or in writing, to third party payors, and/or patients to resolve reimbursement and credit balance issues.
- Responds to requests from third party payors and/or patients regarding reimbursement problems and issues.
- Interacts with and advises internal staff regarding billing and documentation policies, procedures, and serves as liaison with other department representatives to resolve reimbursement and/or credit balance issues.
- Prepares adjustment and refund request forms.
- Collects, analyzes, and summarizes data for preparation of statistical reports; creates and maintains specified data files and logs, maintains computerized systems for collection and tracking of data, and assists in the preparation of reports.
- Ensures strict confidentiality of patient medical and financial records, in compliance with federal and state patient privacy legislation.
- Assists in departmental problem solving, project planning, and the development and execution of departmental goals and objectives.
- May provide task-specific support and guidance to other techs, as appropriate.
- Performs miscellaneous job-related duties as assigned.
High school diploma or GED with at least 5 years of experience that is directly related to the duties and responsibilities specified. Verification of education and licensure (if applicable) will be required if selected for hire.
Knowledge, Skills and Abilities Required
- Ability to identify and resolve reimbursement and credit balance issues related to all medical insurance payor groups.
- Ability to communicate effectively, both orally and in writing.
- Ability to use independent judgment and to manage and impart confidential information.
- Ability to utilize an automated accounting system.
- Knowledge of state and federal patient privacy of information legislation.
- Knowledge of rules governing primary/secondary responsibility and patient responsibility after third party payments and denied services.
- Knowledge of IDX related screens and functions, to include the various reports currently used to identify and resolve credit balances.
- Knowledge of IDX payment and adjustment processes.
- Ability to gather, compile and analyze data.
- Knowledge of general accounting principles.
- Ability to calculate numbers, determine incorrect entries, and post corrections to records.
- Knowledge of computer spreadsheet software.
- Research, analytical, and critical thinking skills.
- Must be employment eligible as verified by the U.S. Dept. of Health and Human Services Office of Inspector General (OIG) and the Government Services Administration (GSA).
- Must pass a pre-employment criminal background check.
- Fingerprinting, and subsequent clearance, is required.
- Must provide proof of varicella & MMR immunity or obtain vaccinations within 90 days of employment.
- Must obtain annual influenza vaccination.
- If this position is assigned to a clinical area, successful candidate will be required to complete a pre-placement medical evaluation/health screen. Required N-95 mask fitting, testing, vaccinations to include annual TST, Tdap, and Hepatitis B will be determined based on location and nature of position.
Working Conditions and Physical Effort
- Work is normally performed in a typical interior/office work environment.
- No or very limited exposure to physical risk.
- No or very limited physical effort required.