JOB SUMMARY

Responsible for the insurance billing process between the hospital and insurance companies, federal agencies and third party payers. Audits patient accounts to ensure procedure, charges and coding accuracy. Effectively bills claims electronically and coordinates and maintains updated edits. Collects payments from payers and posts to patient accounts promptly and accurately. Resolves all credit balances and follow up on aged accounts timely. Immediately supervised by Patient Accounting Team Lead. Reports to Patient Accounting Manager. Non-Exempt position.

ESSENTIAL FUNCTIONS

Works daily electronic billing files and submits insurance claims to payers either electronically or paper in a timely manner to avoid denials due to filing deadlines.

Reviews daily edit reports from the hospital billing system and makes necessary corrections to allow electronic submission.

Monitors bill holds and coordinates with other departments to resolve issues and facilitate timely claim submission.

Reviews claims for accuracy and coordinates with revenue departments, RAC Coordinator, or HIM as needed to resolve questions related to medical codes, modifiers, and/or other elements present on the claim form.

Ensures timely and accurate submission of insurance claims to all payers and documents billing activity in the patient accounting system.

Reviews electronic orders for additional information not sent on the interface transmission (i.e. handwritten information, attachments, and copies of insurance cards) and updating system accordingly.

Responsible for translating claims into the hospital Clearinghouse Billing Software System.

Prepares and submits manual insurance claims to payers who do not accept electronic claims or who require special handling.

Performs specialized processing for accounts missing information (i.e. update patient/guarantor demographics number, CPT codes, etc.)

Prompt follow-up efforts on aged accounts, which may involve formulating written appeals or write offs, in a timely manner to avoid missing filing/appeal deadlines.

Responsible for correcting billing information when applicable (i.e. update patient/guarantor demographics and/or insurance information).

Interprets coding demographic information is correct.

Researches multiple systems for missing information and examining historical data to obtain missing information and retrieve compliance guidelines.

Monitors claim rejections for trends and issues; reports these findings to the Business Office Supervisor and other Department Directors.

Responsible for reviewing and resolving accounts on Clearinghouse rejection reports in a timely manner to avoid missed claims/appeals filing deadlines.

Responsible for reviewing and/or resolving credit balances (credit balance report to be worked monthly).

Coordinates the payment process and collects payments from insurance companies, federal and state agencies and third party payers.

Documents billing activity on the patient account. Ensures hospital compliance with all state and federal billing regulations and reports suspected compliance issues to the Business Office Team Lead.

Responsible for contacting the appropriate agency/company to resolve account collection problems.

Responsible for working remittances upon posting. Collector to move monies to appropriate insurance bucket for follow up.

Responsible for setting follow up through Reminder Desktop for appropriate follow up.

Documents all correspondence and conversations with insurance companies, governmental agencies, third party payers and patients on patient’s account

Responds to patient concerns and/or complaints on a routine basis and keeps departmental leaders apprised of these issues

Identifies barriers to effectively enhance departmental operations and takes an active role in developing appropriate and effective solutions

Responds promptly to patient inquiries regarding hospital billing procedures, policies, and statements. Collector to generate itemized bills upon request

Answering patient and third-party questions and/or addressing billing concerns in a timely and professional manner.

Accepts other assignments as needed.

POSITION REQUIREMENTS

Minimum Education

High school diploma or GED required.

1 year of customer service and/or business office experience in a medical setting required.

1 year previous billing experience preferred.

Required Skills

Must possess superior ability to communicate effectively in English, both verbally and in writing. Additional languages preferred.

Excellent interpersonal skills and customer service.

Must possess high degree of organization and be able to multi-task efficiently and effectively.

Advanced computer knowledge required, including proficiency in Microsoft Office and Outlook.

Ability to use standard office equipment (copier, fax, etc.).

FUNCTIONAL DEMANDS

Functional Job Requirements:

Job requirements include, but are not limited to: sitting, standing, walking, kneeling, bending, squatting and reaching. Requires good finger dexterity, repetitive motions with hands and fingers. Requires ability to have good vision and hearing. Pushing and pulling equipment may be necessary.

Lifting Requirements

Job requires medium lifting on an occasional basis.

Reasonable Accommodations

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising the job duties.