Job Code/Title: B2021/ Acct Operations Tech 2
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.
This position is responsible for following up on all unpaid claims after the appropriate time frame and/or working to clear claim edits which prevent the claim from going out to the payer.
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.
Performs a variety of routine to complex day-to-day operations that may involve independent research, investigation, and problem resolution, in support of the administration of billing accounts for a defined University medical service or billing agent. May provide task-specific support and guidance to new and/or lower level Account Operations techs, as appropriate.
Duties and Responsibilities
- Processes and researches electronic data interchange (EDI) reimbursements from various payers; processes EDI payments, contractual allowances, and related transactions on patient invoices, as required.
- Performs daily and monthly reconciliations to the general ledger, to include reclassifications; receives and balances documents of deposits received, and distributes remittance advices.
- Researches and analyzes claims from various government and commercial third-party payers; verifies patient eligibility, and adjusts and resubmits claims.
- Researches and analyzes third-party payer remittance documentation in order to reconcile payments to remittance advices; reconciles and applies changes and corrections to patient invoices and accounts.
- Follows up directly with third-party payers and/or patients, either by telephone or in writing, to resolve outstanding accounts receivable issues.
- Ensures strict confidentiality of patient medical and financial records, in compliance with federal and state patient privacy legislation.
- Interfaces with other department representatives in the resolution of identified problems and issues.
- Participates in the development and execution of departmental goals and objectives.
- Collects, analyzes, and summarizes accounts receivable data for problem resolution and effective data management.
- May provide task-specific support and guidance to other techs, as appropriate.
- Prepares adjustment and refund request forms.
- Performs miscellaneous job-related duties as assigned.
Minimum Job Requirements
High school diploma or GED with at least 3 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
- Demonstrated skill in resolving medical payment issues with third-party payer groups.
- Ability to gather data, compile information, and prepare reports.
- Ability to communicate effectively, both orally and in writing.
- Analytical and problem solving skills.
- Ability to maintain confidentiality of records and information.
- Knowledge of medical terminology, ICD-9, and CPT coding.
- Thorough working knowledge of medical billing, accounts receivable, and payment reconciliation.
- Knowledge of IDX payment and adjustment processes.
- Ability to make administrative and procedural decisions and judgments on sensitive, confidential issues.
- Demonstrated skills in the use of personal computers and medical software.
- Working knowledge of electronic data interchange (EDI) reimbursement procedures and systems.
Conditions of Employment
- 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.
- Moderate physical activity. Requires handling of average-weight objects up to 25 pounds or standing and/or walking for more than four (4) hours per day.