Denials/Payment Review/Transplants Coordinator (Patient Account Coordinator 1)

Department Overview

This position is responsible for all aspects of the CCMC Denial, Payment Review and Transplant team operations.

Function/Duties of Position

Facilitate and coordinate the daily operation of the CCMC Denial, Payment Review and Transplant units/teams.

• Monitor follow-up worklists. 
  • Develop and maintain an action plan to ensure that billing WIP goals and follow-up WIP goals are met by the end of each week. 
• Act with delegated authority as a liaison between Director and staff. 
  • Expedite assistance for staff with questions or issues and promote revenue collection/resolution.
• Analyze workflow and implement process improvement solutions when necessary.
• Provide leadership within the Denial, Payment Review and Transplant team and actively participate in other roles within the department.
• Develop detailed knowledge of government programs, regulations, and reimbursement methodologies.
• Represent Director and PBS to outside payers, agencies, and OHSU departments.
• Review all accounts on Denial, Payment review and Transplant high dollar reports to determine if assistance is needed to ensure prompt resolution; coordinate with staff as necessary to expedite payment.
• Monitor monthly aging reports and Epic WQ’s to ensure timely resolution of payments.
• Perform team account reviews to ensure quality follow-up and collection of accounts.
• Work with teams to update and maintain procedures and compile training manuals.
• Monitor bulletins released by CMS/Medicare and websites/newsletters released by payors 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.
• Ensure guidelines are implemented, enforced and updated as appropriate.
• Assist with the implementation of regulatory changes. 
  • Work with PBS staff, other OHSU departments and third parties as necessary.
• Assist with coordinating responses to for some CCMC audits as appropriate (outside of line level audits.).
  • Maintain files for retention.
• Support Manager/Director as needed in working with OHSU’s Office of Integrity and/or legal department.
• Perform internet research of  third party payors regulations and provider rules to provide OHSU departments with requested information.
• Timekeeping.
  • 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.
  • Review and authorize vacation schedules and reallocate work as appropriate.
• Attend Aeos Metric Meetings monthly meetings and weekly Management Team meetings.
  • Update team following meetings.
• Review the Huron 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.
• Other duties as assigned within the scope of the established class specifications; includes team support and environmental activities.

Required Qualifications

• 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.  
• CRCS certification required.  

Preferred Qualifications

• 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 ex