Revenue Cycle Hospital and Professional Insurance Services

The Vendor is required to provide revenue cycle hospital and professional insurance accounts receivable (A/R) management to accelerate and increase overall cash collections and decrease accounts receivables.
- Provide health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help, and other services.
- Work directly in the core billing system to produce and submit the claim per the currently established procedure
- Responsible for all follow-ups with third-party insurance to ensure payment is received.  
- Responsible for working on no response and denials from the pay or directly in the core billing system
- Agree to work and perform the following duties, including but not limited to:
• Post adjustment within the core billing system.  
• The vendor agrees to approve adjustments in the core billing system in alliance with agency approved policy and ensure adjustments are made each Friday by noon as well as the last day of the month by noon
• Resolve accounts within the assigned edit work queue in the core billing system (work queues could include claim edit, account, charge review, charge router)
• Resolve accounts within the clearinghouse work queue to ensure the claim is on file with the insurance company
• Review and respond promptly to all issues raised by agency staff, including, but not limited to, coordination of benefits issues.
- Transmit weekly account updates in the agency -defined electronic format, including all payments and/or adjustments posted to accounts.
- Agency reserves the right to remove a vendor employee from working our accounts.
- Receive weekly account updates in agency -defined electronic format to include all adjustments and comments posted to accounts.
- Receive monthly reports of performance to be defined by agency.
- Reports may include, but are not limited to, referral volume, collection rate, and performance analysis.
- Complete monthly reconciliation of active accounts to monitor host system accuracy of referred inventory.
- Participate in weekly operation review conference calls with the vendor to solicit account status.
- Participate in monthly and/or quarterly virtual operation alignment and performance improvement meetings.
- Close and return any accounts to agency upon agency request without fee at any time.
- Email all system access and termination requests promptly to agency designated representatives.
- Demonstrate a partnership relationship with agency to identify billing deficiencies, system-related billing issues, and other problems inhibiting prompt, efficient accounts receivable resolution.
- Accept guidelines outlined in writing by the agency that establish routine procedures for handling daily business.  
- This includes but is not limited to guidelines established for requests for information, requests to verify payments and responses to third-party insurance carriers or their representatives.
- Provide weekly reports of performance indicators mutually agreed upon by agency and the vendor.
- These will include, at a minimum, gross placement, recalls and returns, cancellations, net placements, cash collected, etc.
- Contract Period/Term: 3 years