Account Assistant IV

Yale University - Yale Health Plan

Under the direction and supervision of the Billing Supervisor, process and coordinate billing activity for Yale and Non-Yale Worker?s Compensation and Subrogation cases.  This position is also responsible for the Account Receivable billing and collection process for Medicare, Commercial Insurance carriers and FFS accounts and working with Yale?s Workers Compensation Department related to any billing issues or discrepancies.

 

Essential Duties of the Position:

1.  Serve as a principal source of information on rules and procedures regarding YUHS billing practices. Complete A/R Billing and Collection process related to Yale and Non-Yale Workers Compensation cases. Responds to requests from Third Party Administrators related to Non-Yale workers Compensation claims.

2.  Investigate and resolve misdirected payments to/from YUHS. Research and respond to any delays in reimbursement from third party insurance carriers for billed services.  Respond to requests from outside payors and provide additional documentation and information for specific billed services in order to substantiate and expedite payment.  Communicate with vendors, other Yale departments and/or members on any delays in payment.

3.  Generate, review and distribute claim forms to Insurance payers and FFS accounts.

4.  Reconcile IDX Billing Edit Lists for Student Waiver, Medicare, Commercial Insurance, Subrogation cases and any other payers.  Maintain and update all Student Waiver, Medicare, Commercial Insurance and FFS information in IDX.  Assist with the maintenance of IDX Dictionaries and related projects as necessary.

5.  Apply insurance, premium and third party payments in IDX related to Bursar, Medicare, Commercial Insurance, Attorneys, Automobile Insurance carriers, Third Party Administrators, FFS and Workers Compensation carriers.

6.  Submit appeals and grievance complaints for inappropriately denied claims. Send out denial notice letters and bills to patients when Workers Compensation has denied charges related to services rendered at the YUHS Clinic.

7.  Maintain, update and monitor accounts receivable activity for YUHS Pharmacy. Provide backup support for cash application functions related to Pharmacy deposits including balancing and setup of cash drawers, prepare deposits, entering RIF?s and making daily deposit runs to the Treasurers Office.

8.  Provide coverage within the Billing Department for breaks and lunch hours as necessary.

9.  Special projects as assigned and other duties related to the function of the YUHS Billing Office.

 

Experience and training:

1.  Four years of related work experience, two of them in the same job family at the next lower level, and high school level education; or two years of related work experience and an Associate degree; or an equivalent combination of experience and education.

2.  Two to three years previous subrogation experience with a complete understanding of Workers Compensation, TPL and MVA processes.

3.  Strong knowledge base in medical billing and collections; third party insurance carriers and Medicare.

4.  Previous experience with litigation, attorney requests and Workers Compensation policies and procedures as outlined by State and Federal Law.

5.  Thorough knowledge and working experience with CPT, ICD-9-CM, HCPCS and Level II Modifier coding.

6.  Preferred:  working knowledge of ERISA Plans; state and federal insurance regulations and guidelines pertaining to billing and record retention; IDX BAR System and Oracle: current CPC.

7.  Working knowledge of appointment scheduling, referrals and authorizations

 

Skills and abilities:

1.  Ability to work independently, organize and prioritize work assigned in order to meet goals and deadlines.

2.  Superior time management skills.

3.  Excellent attendance and punctuality.

4.  Superior customer service/interpersonal skills with the ability to deal with people in a tactful and courteous manner.

5.  Proficient in Microsoft Office (Word, Excel) and data entry skills.

6.  Excellent verbal and written communications.

7.  Ability to work in a high pressure environment and respond to tight deadlines.