At Powell Valley Healthcare, providing quality healthcare to our community is our top priority. We are located in the heart of Powell, Wyoming; just 25 miles outside of Cody. We believe in creating positive and safe environments for both our patients and our staff. Being part of our organization means becoming a cornerstone in the patient experience and their care.
Here at PVHC, we offer a wide array of benefits in a way that allows you to choose options and build a package that works best for you. Some of the benefits we offer to our full-time and part-time staff include:
- Health, dental and vision insurance
- Life insurance
- Long term disability coverage
- PTO – New employees accrue the equivalent of up to twenty days of PTO withing their first calendar year
- EIB (Extended Illness Bank) – Our version of accrued sick leave
- Paid Holidays
- Tuition Savings Plan
- Opportunities to cash out PTO for personal use, student loan payments, and in-house medical bills
- Tuition reimbursement – up to $5,000 per year
- Fun to be Fit program and Club Dauntless Membership Discount
- HRA – Flex spending accounts
POSITION SUMMARY:
Current Opening: One full-time position; 40 hours per week (8:00 AM – 5:00 PM Monday – Friday) with potential to work remotely.
Responsible for the review of billing data for accuracy and completeness to resolve edits or exceptions during system processing of the claim. Applies modifiers and combines or splits accounts when appropriate. Analyze accounts for specialized billing requirements to prevent delays in payer processing and identifying denial trends.
ESSENTIAL FUNCTIONS:
- Analyze and resolved specific billing edits to transmit/bill claims within 5 days of final coding.
- Apply billing modifiers, occurrence codes, and condition codes.
- Resolve billing edit failures within 3 days of final coding.
- Implement billing edits or bridge routines to maintain claim rejection at 10% or less.
- Monitor payer requirements to ensure claims are billed prior to timely filing deadlines.
- Perform daily reconciliation between Cerner and Assurance to ensure claims are interfacing between systems.
- Work with PFS Director to research credit balances for governmental payor and file claim adjustments as required by regulation.
- Submit adjustments for nonbillable/noncovered account charges and/or balances.
- Resolve Cerner technical denials within 5 days and report trends to PFS Director.
- Keep current on regulatory requirements and best practices and provide information to the PFS Director, assist with implementation as requested.
- Utilize effective documentation standards that support a strong historical record of actions taken on the account.
- Work effectively with coding and ancillary departments on billing related issues.
- Adjust/correct Medicare claims using DDE system.
- Provide training/re-training to PFS department employees.
- Work closely with claims resolution staff to resolve and prevent future insurance denials.
- Perform other duties as assigned.
KNOWLEDGE, EDUCATION AND EXPERIENCE PREFERRED:
- High school diploma or General education degree (GED) required.
- 5-7 years’ experience in patient financial services position.
- Demonstrated knowledge, experience and skills in using business software applications: Windows environment on PC, Microsoft Excel, Word Processing, Small Business Applications, Healthcare System Applications – primary focus on accounting and financial functions minimum two years’ experience required four years’ experience preferred.
SKILLS AND ABILITIES REQUIRED:
- Strong working knowledge and skills in essential accounting functions
- Skills in operation of typical office equipment such as PC’s, printers, terminals, calculator, FAX, Copiers.
- Knowledge and experience in using, Windows Excel and Word as well as small business application, and Health Care systems Applications – primary focus on accounting and financial functions.
- Read, write and comprehend instructions, memos, and correspondence.
- Communication skills – written & verbal – peers/management.
- Ability to apply basic mathematical concepts such as adding, subtraction, multiplication, and division in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, percent and other mathematical outcomes, and to draw and interpret bar graphs.
- Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
PHYSICAL DEMANDS/REQUIREMENTS:
- Regularly lift or move objects weighing 10 lbs., frequently lift and/or move up to 25 lbs.
- Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision, and depth perception.
- Reaching, handling, feeling, talking, hearing, stooping, bending, crouching, and working with equipment.
- The employee is also subject to exposure to blood and body fluids, proximity to moving mechanical parts, electrical shock, exposure to burns and radiant energy, exposure to explosives, exposure to toxic chemicals and biological agents.