Essential Duties & Responsibilities:
- Utilizes various hospital/physician systems to verify patient, billing and claim information for accuracy.
- Performs compliant primary/secondary, tertiary and re-bill billing functions, including electronic, paper and portal submission to government and/or commercial payers.
- Edits claims to meet and satisfy billing compliance guidelines for electronic and hardcopy submission.
- Responds timely to emails and telephone messages, as appropriate.
- Communicates issues to management, including payer, system or escalated account issues.
- Participates and attends meetings and training seminars, as requested.
- Adheres to professional standards, hospital policies and procedures, federal, state, and local requirements, and JCAHO standards.
- Enhances billing department and hospital reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.
- Updates patient demographics/insurance information in appropriate systems.
- Monitors claims for missing information, authorization and control numbers (ICN//DCN).
- Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems.
- Secures needed medical documentation required or requested by third party insurance carriers.
- Maintains and respects the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure.
- Utilize provider billing manuals to obtain billing guidelines and requirements
- Import verification and escalation of import/export files
- Special Handling billing included not limited to interim bills, overlap review, redistribution of money for correct claim creation
- Resolve and research billing Rejections
Qualifications:
- 2+ years of medical collections/billing experience
- Intermediate knowledge of ICD-10, CPT, HCPCS and NCCI
- Intermediate knowledge of third party billing guidelines
- Intermediate knowledge of billing claim forms(UB04/1500)
- Intermediate knowledge of payor contracts
- Working Knowledge of Microsoft Word and Excel
- Intermediate working knowledge of health information systems (i.e. EMR, Claim Scrubbers, Patient Accounting Systems, etc.).
Preferred Requirements & Competencies:
- Working knowledge of one or more of the following Patient accounting systems – EPIC, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts, or Paragon
- Working knowledge of DDE Medicare claim system
- Knowledge of government rules and regulations
