GENERAL SUMMARY OF DUTIES
Processes claims electronically to insurance carriers. Mails claims to carriers when required. Works all billing vendor edits including Medicare Service Center daily unbilled reports. Work account delays from the hospital bill alert reports daily. Responsible for posting correct late charges to accounts. Communicates any charge related issues to Charge Master Manager/Analyst.
DUTIES INCLUDE BUT ARE NOT LIMITED TO:
Works all identified insurance requirement edits through the electronic billing system.
Communicates issues with patient access and facility departments.
Researches required information and maintains pending follow up on a daily/weekly basis.
This applies to all untransmitted pending claims.
Communicates daily information needed for billing to the Medicare Service Center via action notes
Daily transmits all electronic claims to the billing vendor to be sent directly to the insurance carriers.
Daily works electronic insurance rejects in order to retransmit with corrected insurance information.
Daily works rebills submitted to the billing department through the electronic billing system.
Daily/weekly verifies that all electronic acknowledgements were received by the insurance carriers.
Daily submits required paper billing to insurance carriers.
Attach I-bills, ER records, implant invoices to paper billing when required.
Maintain daily follow up with the facility late charge reports.
Late charges to be reviewed based on specific insurance payor requirements.
Submit adjustment requests to Medicaid through online automated system.
Work the unbilled alert and comp census reports daily.
Work the Medicare 72 hour and Medicaid 24 hour reports to identify Compliance overlapping accounts.
Transfer charges when appropriate.
Work all related Medicare APC edits that appear on the bill alert reports and communicate with facility
departments in order to resolve.
Work the lab compliance related edits and communicates issues with facility lab directors.
Enter notes in the collection system of action taken.
Record daily productivity on excel spreadsheet.
Practice and adhere to the "Code of Conduct" philosophy.
Attend all required billing education classes.
Other duties as assigned.
KNOWLEDGE, SKILLS & ABILITIES:
Communication - communicates clearly and concisely, verbally and in writing.
Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
Interpersonal skills - able to work effectively with other employees, patients and external parties.
PC skills - demonstrates proficiency in PC applications as required.
Policies and Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems.
Basic skills - able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately.
At least one year billing experience required.
Relevant education may substitute experience requirement.
PHYSICAL DEMANDS/WORKING CONDITIONS
Requires prolonged sitting, some bending, stooping and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Requires lifting papers or boxes up to 25 pounds occasionally. Work is performed in an office environment. Work may be stressful at times. Contact may involve dealing with angry or upset people. Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergency situations.