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Directs and coordinates activities of employees engaged in reimbursement activities including conducting credit investigations and collecting delinquent accounts of customers. Reviews collection reports to ascertain status of collections-and-balances outstanding and to evaluate effectiveness of current collection policies and procedures. Assigns employees, directly or through subordinate supervisors, responsibility for notifying or locating customers with delinquent accounts and attempting to secure payment, using postal services, telephone, or personal visit; mailing form letters to customers to encourage payment of delinquent accounts; conferring with customers by telephone in attempt to determine reason for overdue payment; auditing delinquent accounts considered to be uncollectible to ensure that maximum efforts have been taken before assigning bad-debt status to accounts; coordinating with others, including personnel in credit card companies, to exchange information and update controls. Supervisors may report to this position.: Prepares and controls departmental annual budget. May negotiate major claims with insurance companies or other third party payers. May recruit, hire, train staff, evaluate employee performance, and recommend or initiate promotions, transfers, and disciplinary action. May submit delinquent accounts to attorney or outside agency for collection.

Head of Reimbursement

Medical Reimbursement Head

Medical Records Coding Technician

Compiles and maintains medical records of patients of health care delivery system to document patient condition and treatment. Reviews medical records for completeness and to abstract and code clinical data, such as diseases, operations, procedures, and therapies, using standard classification systems. : Compiles medical care and census data for statistical reports on types of diseases treated, surgery performed, and use of hospital beds, in response to inquiries from law firms, insurance companies, and government agencies. Maintains and utilizes variety of health record indexes and storage and retrieval systems. Operates computer to process, store, and retrieve health information. Assists Medical Records Administrator in special studies or research as needed. May code medical records for reimbursement purposes.

Compliance and Coding Specialist

Monitors and implements compliance procedures covering the privacy of access to patient health information. Reviews medical records for completeness and to abstract and code clinical data, such as diseases, operations, procedures, and therapies, using standard classification systems. Typically exists in a health plan or within a medical facility or institution. Typically requires the equivalent of an associate's degree and two to three years of related compliance experience and training in CPT and ICD-9 coding.: Coordinates all internal and external changes associated with products or services to assure legal compliance with regulatory guidelines. Conducts regular compliance audits and investigates/resolves complex compliance issues. Compiles medical care and census data for statistical reports on types of diseases treated, surgery performed, and use of hospital beds, in response to inquiries. Develops and maintains an organized, methodical documentation system for communicating, implementing, and managing new and existing regulatory requirements. Establishes and administers a process for receiving, documenting, tracking, investigating, and taking action on complaints concerning privacy policies and fraud concerns. Organizes and maintains files of contracts, records, and correspondence. Maintains and utilizes variety of health record indexes and storage and retrieval systems. Operates computer to process, store, and retrieve health information. Prepares, proofreads, and distributes reports, correspondence, forms, etc., of a specialized and confidential nature. May assist in the development of contracts and procedures to ensure compliance. May also develop, implement, coordinate, and monitor a fraud and abuse compliance program. May deal with patient/client files and other patient/client specific information of a confidential nature.

Patient Resources & Reimbursement Agent

Investigates financial assets, properties, and resources of hospitalized retarded and brain-damaged clients to protect financial interests and provide reimbursement of hospital costs: visits and interviews or contacts by mail or telephone relatives, friends, former employers, pension funds, fraternal and veterans organizations and government agencies. Records documentation of financial resources in patient files. Analyzes data accumulated, such as disability allowances, medicare, medicaid, social security pension, dividends, interest, and insurance, and determines ability to pay for hospitalization. Determines additional sources from which reimbursements can be obtained. Prepares reports and enumerates amounts and sources of reimbursements, including public assistance from social agencies in behalf of patients and families. Reviews patients' records to ensure that reimbursements are maintained. Applies for appointment of conservators to financially protect patients with assets over statutory limits and submits names of appointees to courts. Occasionally attends court hearings to protect patient interests.

Coding Specialist

Evaluates and codes medical records data for statistical and billing purposes, using standard classification system: Reviews medical records to abstract data concerning patient's medical condition and treatment or procedures rendered. Contacts medical service providers to clarify or confirm diagnoses and procedures. Analyzes and interprets abstracted data, applying knowledge of medical reference manuals for assistance with interpretation of data. Codes medical terms corresponding to patient's diagnosis and treatment, using computerized classification systems. Enters assigned codes into online database for subsequent retrieval and use in billing or statistical compilation. |May manually code medical data, using standard classification system manuals and code books. May bill patients or medical insurance companies for services rendered, and be designated Medical Coder-Biller.

Reimbursement Analyst

Analyzes and records the impact of basic reimbursement issues related to billing, collecting, and reporting of professional and medical services to ensure recovery of all inpatient and outpatient charges. Monitors and evaluates current reimbursement and payment rules and ensures that legislative and regulatory changes impacting medical billing are anticipated and communicated. Typically requires a college degree in accounting or finance and knowledge of CPT and ICD-9 coding.: Assists physicians in determining appropriate use of codes for maximizing reimbursement of services. Develops techniques for effective analyses of billing and collections efforts. Provides reimbursement patterns and trend analyses for various departments. Provides in-service training programs for departmental billing personnel and clinical faculty. Assists in resolving third party denials received as well as reimbursement appeals and problems. Prepares reports and analyses.

Reimbursement Recovery Specialist

Monitors and negotiates cases where third-party liability reimbursement exists. Investigates and identifies responsible third parties, determines liability, and uses all available resources to maximize the recovery. Prepares Medicare, Medicaid, and other third-party payer cost reports. Assists with various other reimbursement analyses and payment requests.: Investigates codes in which insurance companies disallow reimbursement. Coordinates changes in insurance regulations and provides in-servicing to other patient account representatives. Corresponds with third-party insurance companies who provide them with information necessary to assist them in determining more appropriate reimbursement levels. Updates physicians regarding preferred CPT codes. May negotiate home care reimbursement.

Coding File Clerk

Classifies materials according to subject matter and assigns numbers or symbols from predetermined coding system to facilitate accurate filing and reference: scans correspondence, reports, drawings, and other materials to be filed to determine subject matter. Ascertains specified number or symbol, using code book or chart, and marks or stamps code on material. Assigns cross-indexing numbers if subject matter should be classified and filed under more than one heading. May revise coding system to improve code usage.

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