JOB SUMMARY: The Inpatient Billing Specialist is responsible for billing inpatient charges for all insurances and to self-pay consumers. He/she is responsible for auditing accounts after payments and doing write-off sheets and reviewing payment and prepared adjustments.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES: The list of essential functions, as outlined herein, is intended to be representative of the tasks performed within this classification with or without an accommodation. It is not necessarily descriptive of any one position in the class. The omission of an essential function does not preclude management from assigning duties not listed herein if such functions are a logical assignment to the position.

• Batch and bill (paper and electronic) inpatient charges to all payers (Medicare A&B, Medicaid MMAs, & Commercial Insurances) both for primary and secondary claims
• Review unpaid claim files every 30 days/ follow up on denied claims
• Work 60 day outstanding A/R report
• Utilize EASE and DDE as a tools for Medicare Part A claims updates and follow-up
• Utilize SPOT as a tool for Medicare Part B claims updates and follow-up
• Copy/File all incoming EOBs and authorizations to corresponding episodes of care
• Review EOBs for accuracy of payments and postings
• File appeals and follow-up if not responded to in a timely manner
• Request medical records for appeals/claims/insurance company inquiries
• Mail letters to inpatient consumers: Insurance Paid Letter, Coordination of Benefits, Denial, etc
• Answer consumer calls/return voice messages/take over the phone credit card payments
• Draw up and send out payment contracts upon consumer request
• Prepare charts for end of month write-offs
• Continue medical billing training/education to ensure accurate billing
• Ability to perform other duties as assigned
• The ability to comply with the regulations requiring a workplace of dignity and respect and equal employment opportunity compliance.
• The ability to work collaboratively with others and to accept constructive criticism from supervisors and managers.
• Willingness to abide by the company’s published rules and regulations

KNOWLEDGE AND JOB SKILLS: Data Entry, Microsoft Word and Excel, Office 365, Common computer skills, Knowledge of basic office equipment, business math, and typing.

COMPETENCIES: Knowledge, Skills, Abilities, and Motivation (KSAM) required for an employee to be successful.

• Serving Our Consumers: Effectively meeting consumer needs, building productive consumer relationships, and taking responsibility for consumer satisfaction and loyalty.

• Consumer Focus: Building strong consumer relationships and delivering consumer-centric solutions.
• Values Differences: Recognizing the value that different perspectives and cultures bring to an organization.

• Effective Communication: Clearly conveying information and ideas to individuals and groups in a manner that engages the audience and helps them understand and retain the message.

• Communicates Effectively: Developing and delivering multi-mode communications that convey a clear understanding of the unique needs of different audiences.
• Manages Conflict: Handling conflict situations effectively, with a minimum of noise.

• Continuous Improvement: The ongoing process of achieving positive changes in service and processes in order to improve efficiency and quality.

• Resourcefulness: Securing and deploying resources effectively and efficiently.
• Cultivates Innovation: Creating new and better ways for the organization to be successful.

• Expertise: Demonstrating proficiency of an employee's skill or knowledge within their field of practice.

• Drives Results: Consistently achieving results, even under tough circumstances.

JUDGMENT/DECISION MAKING: Utilizes established corporate policies and procedures in making decisions. Uses sound judgment in meeting the responsibilities and performing the duties of the position.

EDUCATION & EXPERIENCE:

• • Education:
  o High School diploma required.
  
  • Experience:
  o One-year experience in a medical office setting with extensive computer experience required.
  o Billing experience in a mental health setting preferred.
  o Experience working in EASE, DDE, Availity, Net Smart/Rev Connect, TIER and other related billing systems is preferred

TRAINING & DEVELOPMENT: Completes all requirements according to Individual Training Plan within the first six months of hire and annually. Other training and/or professional development may be assigned due to evolution of programs.

POSITION CONTENT: This job description is not intended to be and should not be construed as an all inclusive list of all the responsibilities, skills or working conditions associated with the position. While it is intended to accurately reflect the position activities and requirements, Management reserves the right to modify, and/or remove duties and assign other duties as necessary.