Reports to: Claims Team Lead / Accounts Receivable ManagerHours: 37 hours per weekRole: Contract ROLE PURPOSEThis role will be responsible for maintaining the unsubmitted ledger for both current and aged claims thus helping to reduce debt by maximising claims submissions and cash collection Their purpose will be to· Deliver timely task achievement· Ensure all claims are collated correctly, efficiently and submitted in a timely manner, in accordance with the relevant contract or commercial agreement· Maintain a high standard of quality checking to minimise the occurrence of pended, returned, rejected or part paid claims· Maintain a minimum level of queried claims on their desks· Ensure that all patients/staff and any other individuals contacting and attending the Blackrock Clinic are dealt with in an efficient, effective and timely manner at all times and be responsible for their own actions. 1. KEY RESPONSIBILITIES · Review Patient claim packs for accuracy and completeness and obtain any missing information required in order to submit the claim for assessment to the relevant Insurer · Identification of claims with errors that cannot be submitted to the Insurers and being pro-active in trying to resolve them in a timely manner · Daily scanning and submissions of claims to relevant third party in accordance with their relevant cut-off dates whilst ensuring swift turnarounds along with a high standard of quality · Assisting in the management of Consultant files ensuring paperwork is chased and received in a timely manner, requesting and copying charts where necessary · Resolution and resubmission of any VHI returns that come back as quality errors · Acquire a full understand of the Insurer contracts and the rules of billing and submissions · Weekly reconciliation of claims submitted to each Insurer between diary entry, OA and the claims summary sheet · Assisting with filing, cash collection and other ad-hoc duties required · Deal with routine calls from patients, consultants and staff, resolving daily or escalating to your Team Lead if further action is required but taking responsibility for ensuring the notes in OA are kept up to date and assisting where possible to close out the query. A professional and courteous approach is expected at all times, for both internal and external stakeholders · Supporting the standardisation and improvement of processes, procedures, controls, and systems · Utilisation of Excel and Word Processing skills to maintain up-to-date spreadsheets and statistics · Contributing to the delivery of key department KPI’s and targets 2. SKILLS AND EXPERIENCE · Numerical and analytical skills · Interest in change management and process improvement · Proficient in Microsoft Excel · Excellent communication skills both verbal & written · Flexible · Positive attitude 3. COMMUNICATION SKILLS · Communicate appropriately with colleagues and other members of the health care teams to ensure a quality service is provided to all while constantly striving for excellence in patient/customer care. · Communicate in a manner that avoids antagonism, reduces conflict and prevents undue anxiety. · Recognise limitations and seek assistance where necessary. · Attend and contribute to appropriate meetings. · Accept constructive advice when appropriate. · Report all incidents immediately, which may adversely affect a patient, colleague or the Blackrock Clinic. 4. GENERAL EXPECTATIONS · Support the philosophy, objectives and goals of Blackrock Clinic · Observe the appropriate lines of authority · Maintain strict confidentiality regarding all patients and the activities of Blackrock Clinic · Demonstrate flexibility to changing work practises and by assisting in all areas of the hospital/clinic as required · Participate in developing and providing quality care within Blackrock Clinic · Assist in orientation of new personnel · Continue to develop personal knowledge and skills and seeks outside educational opportunities · Present a professional appearance and conform to the dress, hygiene and infection control policies of the Clinic · Is always punctual on duty 5. COMPETENTICES Achieving· 'Owns' the strategy: takes personal responsibility for getting done what needs to be done · Deals with problems quickly and directly; doesn't let them fester · Volunteers for tough assignments and projects · Finds opportunities to improve ways of working or outputs · Finds out what customers (internal or external) really want · Resolves customer service problems promptly · Perseveres with extra effort to reach objectives when progress is blocked · Comes up with proposals and suggestions to enhance the performance of the unit · Sets clear, measurable objectives and time-scales for self and others · Clarifies how individual roles contribute to achieving business goals · Prioritises work and activities for oneself and/or others · Allocates time and resources needed for activities · Adapts plans to accommodate changing circumstances · Specifies actions to be taken in response to identified issues and problems · Deals calmly and effectively with crises, unexpected or stress-provoking situations · Displays stamina in pursuing goals and objectives · Works systematically and according to plan in response to tight deadlines Leading · Makes people feel that they are part of a team by emphasising common business goals and sharing successes · Adapts personal style to suit the circumstances and people involved · Shows recognition and appreciation to others for their contributions · Conveys confidence to individuals in their ability to succeed · Supports and encourages team members to overcome problems and challenges · Takes personal responsibility for the consequences of own actions and decisions · Conveys confidence in own ability, decisions and actions · Assigns responsibilities and tasks to staff in line with their abilities and interests · Provides sufficient support to staff carrying out delegated tasks · Shares expertise and experience, even where there may be little personal gain · Builds people's confidence in their ability to succeed · Gives honest feedback in a non-punitive manner to guide development · Finds out subordinates' development needs and career goals · Behaves in a manner consistent with the organisation's values and promotes the organisation's interests even where personal interests are challenged · Sets an example to others through commitment to high personal standards and organisational goals · Gives recognition - makes people feel their contributions matter · Sets an example to others through commitment to high standards · Seeks and probes others’ points of view - generates involvement Relating · Persuading: designs arguments to appeal to others' interests and concerns, pointing out the benefits for them · Keeps people informed and up-to-date through regular, informal contact and meetings · Encourages two-way communication - avoids 'put-downs' and destructive criticism · Presents information in a structured, systematic manner that is easy to follow · Knows how the organisation works, both formally and informally · Recognises what is feasible in the organisation and what is unacceptable · Secures the support of key decision makers for plans and proposals · Concedes own viewpoint in the interests of team goals · Works co-operatively with others from various functions and backgrounds · Being readily approachable and available to others· Listens to others and clarifies issues before proposing solutions · Sees things from other people's points of view · Handles confidential personal information with respect and integrity · Delivers what has been promised · Behaves in a way that is consistent with what he/she says - 'walks the talk' · Accepts feedback from others without defensiveness · Abides by standards and principles, even when inconvenient or disadvantageous · Encourages and accepts points of view that differ from his/her own · Treats colleagues fairly, regardless of their cultural background, gender or lifestyle · Draws on the diverse skills and talents of others, of all levels· Understanding · Evaluates arguments critically, weighing up the pro's and con's · Links information from different sources to identify patterns, trends and solutions · Investigates causes of problems systematically and logically · Recognises limitations of available data; spotting assumptions and risks · Evaluates when it is appropriate to refer decisions upwards · Draws on past experience to anticipate where problems are likely to arise · Copes with ambiguities: does not demand certainty in data to make decisions about approach to adopt · Knows who or where to go to get information · Brings together data from many sources to understand the broad picture · Recognises the wider impact and significance of own decisions and actions · Ensures that documentation is accurate and up-to-date · Uses correct grammar, spelling and punctuation · Experiments with different approaches to find solutions This job description indicates the main responsibilities of the post and is subject to periodic revision and amendment with the post holder
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