The Billing Specialist reviews home visit records for billing purposes (i.e., supplies used, services provided and level of care given) and processes charges for services using a computerized billing system. The Billing Specialist uses ICD-10 and CPT codes throughout the day.

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  Major Responsibilities:

• Ensures timely, complete and accurate submission of billing and invoicing.
• Records receipts to patient accounts in an accurate and timely manner.
• Follows up on denied, under and over paid claims.
• Processes charges using a computerized billing system. Accountable for diagnostic and procedure coding of services within the agency.
• Reconciles encounter forms to daily schedule.
• Researches incomplete charge documents
• Determines appropriate ICD-10 and CPT codes for all charges.
• Identifies corrections for registration.
• Uses ICD-10 and CPT coding.
• Participates in training to improve knowledge of the billing process.
• Reports any billing problems, issues or discrepancies to Business Manager.

Standard Staffing Level Responsibilities:

• Meets established productivity standards.
• Facilitates and promotes the sharing of knowledge and content throughout departments.
• Takes responsibility for ensuring that all work outcomes satisfy the UMass Memorial Health System True North.
• The individual must support the mission, vision, and goals of HealthAlliance-Clinton Hospital and serve as a role model for CARES values.
• Adheres to change control processes.
• Participates in cross training to optimize department resources.
• Demonstrates excellent attendance and actively participates in a variety of meetings and training sessions as required.
• Demonstrates a friendly, responsive, service-minded attitude to all internal and external customers.
• Communicates ideas effectively. Shares information and keeps others properly informed. Gives, and is open to useful feedback.
• Adheres to the HealthAlliance Hospital Code of Conduct and Behavior Standards and dress code.
• Complies with established environment of care/safety policies and procedures and all health and safety requirements.
• Maintains and fosters an organized, clean and safe work environment.
• Contributes to the development and application of process improvements.
• Maintains a collaborative, team relationship with peers and colleagues in order to effectively contribute to the group’s achievement of goals and to help foster a positive work environment.
• Attends staff meetings and in-service programs as required or directed. Keeps current with hospital and unit changes by reading communication boards and/or books, bulletin boards, posted notices and reads and responds to e mails on a regular basis.
• Practices cost containment and fiscal responsibility through the efficient use of supplies, equipment, time, etc.
• Complies with established departmental policies, procedures and objectives.
• Attends variety of meetings, conferences, seminars as required or directed.
• Demonstrates use of Quality Improvement in daily operations.
• Complies with all health and safety regulations and requirements.
• Respects diverse views and approaches, and contributes in maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
• Maintains, regular, reliable, and predictable attendance.
• Performs other similar and related duties as required or directed.

All responsibilities are essential job functions.

• Position Qualifications:

License/Certification/Education:

Required:

• High School Diploma

Experience/Skills:

Required:

• One to three years of medical billing experience.
• Knowledge of medical terminology, ICD-10 and CPT coding.
• Knowledge of billing requirements of third party payors in the State of Massachusetts with ability to maintain current knowledge of coding and billing practices through reading of newsletters, publications and attendance at seminars.
• Ability to organize and prioritize work to meet strict deadlines.
• Strong attention to detail and accuracy.
• Ability to work independently and as a team player.
• Computer skills which include mainframe and PC applications.
• Ability to communicate (read, write and speak) clearly in English

Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents.