Application Specialist

Overview

Responsible for the timely and accurate posting of payments and adjustments into the hospital proprietary billing system. They will be responsible for processing of 835 ERA, ACH, EFT transactions, processing USPS Mail and Inter-office mail, balancing daily batches and assisting with daily reconciliation, initiating and monitoring of automated software posting programs, preparing documentation for reconciliation and auditing. Embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision and values.

USD $16.50/Hr.

USD $24.82/Hr.

High school graduation or GED required;
Associates preferred.

• Education equivalent to graduation from high school or GED is required. Associates preferred.

• Two years of experience in billing, insurance, collections, or related background.
• Previous experience with processing of Insurance and Contractual Allowance aspects of Commercial and Managed Care contracts is highly preferred.

• Ability to read and interpret ERAs, ACHs, EFTs, and EOBs/EOPs.
• Accurate typing of net 30 WPM (alphanumeric).
• Accurate entry of net 6000 KPH (numeric).
• Basic working knowledge of personal computers and associated user software; experience with Microsoft Office Word and Excel preferred.
• Excellent oral and written communication, keyboarding, and basic math skills.
• Ability to work successfully with internal customers and external contacts.

• Access Web Based Portals and download ERA, ACH and report files from payors.
• Prepare files for processing, initiate and monitor Posting Software Applications ensuring adherence to guidelines, timeliness, accuracy, and processing procedures.
• Follow up at prescribed intervals to ensure smooth processing and timely delivery of outstanding payments.
• Investigate assigned payments with incomplete or questionable information and resolve problems or errors to ensure complete information accompanies the payment.
• Calculate contractual adjustments and apply to patients’ online accounts, noting the electronic file accordingly.
• Embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency.
• Receive, sort, and stamp incoming United States Post Office and Inter-department mail; identify and batch 3rd Party and Patient payments for processing.
• Bundle and deliver mail correspondence team for attention and handling.
• Process and analyze Explanation of Benefit (EOB) forms to determine reasons for denial, exclusion, or underpayment.
• Follow up on outstanding or unapplied payments and other issues associated with payments.
• Research and resolve complex issues associated with payments on patient accounts; identify, document, and report problematic trends to management as applicable.
• Analyze reports containing rejected payment information, perform necessary research to resolve reasons for rejection.
• Prepare daily bank deposit and arrange for daily delivery or pick to/from the Security Department.
• Provide input regarding system edits designed to identify and ensure consistent and compliant data necessary for processing patient payments.
• Communicate and resolve issues with internal sources to resolve issues involving patient payments.
• Initiate corrections to charges and contractual allowances within scope of expertise and authority granted.
• Adhere to HIPAA Privacy Regulations and maintain patient confidentiality.
• Identify and calculate write-off amounts and secure necessary approvals from management for processing.
• Document online systems and electronic files to ensure accurate data noted regarding payment status.
• Perform filing and retrieval of electronic and paper forms and files; maintain files according to prescribed procedures and arrange for long-term storage of EOBs or other items.
• Orient and cross-train on other unit duties as directed and defined by management; serve as a backup for other areas during special needs or staff absences.
• Perform other related work as required or requested.

The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job. Incumbents may be requested to perform tasks beyond those specifically presented in this description.