Area of Responsibilities

• Maintains good working relationships with other teams, which includes transferring responsibility for accounts only when such transfers are justified. Success in this area will result in maximum harmony and cooperation between teams. Reviews Medicaid Secondary Payer cases on a regularly scheduled basis to assure that none are forgotten or neglected. Takes steps necessary to obtain payment, including conducting In-depth investigations to determine circumstances surrounding Accidental injuries. Success in this area will eliminate the possibility of undesirable build up of accounts in the advanced aging categories. Contacts patient to encourage The update of COB with Medicaid to ensure proper billing of primary and secondary claims
• Maintains high level of expertise in Medicaid and CMO rules, regulations, policies and procedures by reading and studying applicable bulletins, transmittals, and manual revisions. Maintains up-to-date Medicaid and CMO manual.
• Prepares regular productivity reports which indicate the number of units of work, of various types, completed within a specified time frame. Analyzes numbers to assure that the team, and each of its members, is producing a satisfactory volume of work. Analyzes, then explains substantial increases or decreases in units of work completed. Submits reports to billing Supervisor on a regular basis. Reviews Reminders Worklist and Billers Queue for claims that need follow-up or corrections to claims, contacts appropriate departments for corrections to claims and follow-up with departments for resolution. Strives for 80% clean claim production.
• Provides complete and comprehensive customer service function within its area of responsibility, including responding to patient inquiries and complaints, from all sources, in a timely manner. Initiates necessary corrections to patient accounts, and attempts to repair any damage which may have been done to patient goodwill. This function requires substantial interaction with other departments, and physician?s offices. Success in this area will be indicated by most problems being solved at team level, with very few complaints reaching the supervisor, department director, patient representative, or administration.
• Reviews data contained in all bills, face sheets, HCFA physician claims and UB04's prior to billing to ascertain that none go out which are certain to return. Reviews for missing charges. Success in this area will result in quicker turn around in receivable dollars, and less rework. Reviews edits and errors found through billing software. Contacts and follows up with departments on issues found that need to be corrected by department. Reviews Claims Generated reports to Supervisor.
• \Identifies outliers and obtains appropriate supporting documentation, and submits to Medicaid. The effect of not following through with this will be lost revenue, for these claims.
• Analyzes individual accounts within area of responsibility and develops a Medicaid follow-up and collection strategy which will result in payment of benefits in the shortest time possible. Success in this area will contribute to lower A/R days and improved cash flow in the teams area of responsibility.
• Analyzes returned claims for the purpose of recognizing reasons for return and takes steps to eliminate problems, up to and including recommending changes to processes. Success in this area will result in lower A/R days and improved cash flow in area of responsibility.
• Analyzes work on hand, on a daily basis, and determined how to allocate manpower to achieve the greatest benefit to the area of responsibility. Determines when extra effort, such as overtime or weekend work is needed, but is always mindful of the departmental budget and labor cost. Keeps the billing supervisor/department director informed when overtime might be required.
• Ascertains that inpatient and outpatient pre-certs are done within time limit established by Medicaid.
• Evaluates the performance of the team and each of its members on an ongoing, informal basis. Performs formal team self-evaluation not less than semi-annually. Reports findings and recommendations to Billing Supervisor. Success in this area will result in most productivity problems being resolved at the team level before they become major concerns.
• Identifies out-of-state Medicaid cases and forwards to contract agency for billing and follow-up. (Jennifer Loomis).
• Interviews prospects for placement on the team. Assesses likelihood that candidates will fit in and be able to contribute to the overall improvement of the team and the business office. The team�?s impressions and recommendations will be considered by department director in making a final hiring decision.
• Maintains good working relationships with physician�?s office personnel for the purpose of facilitating the exchange of mutually necessary information.
• Monitors appropriate segments of monthly A/R Analysis by Financial Class� report to identify areas of concern, and develop a strategy and action plan for concentrating on areas needing and most the most immediate attention. Success will be measured by reduction in dollars and number of accounts in the advanced aging categories.
• Monitors work flow for the purposes of identifying and recommending solutions to problems which cause delays in claims reaching readiness for billing. Success in this area will contribute to lower A/R days and improved cash flow in the teams area of responsibility.
• Posts to, and balances Medicaid revenue logs. Purges logs on a regular basis to assure that inappropriate cases are deleted. Assures that general accounting is provided with information on schedule. Assures that electronic transmission of claims is done on a daily basis. Success in this area will assure that all claims reach the payer?s hands at the earliest time possible. Reports any issues with transmission of claims to Supervisor or in Supervisor?s absence, reports to billing vendor or IS Team for resolution. Assists with resolution and testing.
• Prepares monthly and yearly Medicare/Medicaid crossover bad debt contractual report, and submits to general accounting on schedule.
• Prepares regular performance reports, which differ from productivity reports in that they report the impact of work done, rather than counting units of work. This will be done through analysis of aged trial balances, other A/R reports, tracking of customer satisfaction, and calculation of A/R days with in the area of responsibility.
• Processes retroactive Medicaid cases.
• Provides complete and comprehensive Medicaid billing and follow-up services, including Medicaid as secondary payer, to all patients within area of responsibility within payer timely criteria and guidelines.
• Provides high quality services to all of its customers, which includes, but is not limited to patients, physicians, other departments, other teams, Medicaid intermediary and third party payers.
• Remains constantly alert for process improvements which could lead to better results within assigned area of responsibility. Recommends changes when it is felt that change would be beneficial. Implements approved changes.
• Reviews remittance advice for rejected, and denied statuses and balances to the actual check.

Compliance Statement
Employee performs within the prescribed limits of Tanner Health System's Ethics and Compliance program. Is responsible to detect, observe, and report compliance variances to their immediate supervisor, the Compliance Officer, or the Hotline.

Education
High School Diploma or GED

Experience
Two years of related experience. Requires working knowledge of specialized practices, equipment, and procedures.

Licenses & Certifications

• NONE REQUIRED

Supervision

• No supervisory responsibilities, but must be able to function as members of a work team.

Qualifications

• Ability to analyze and prioritize workloads.
• Ability to understand claims issues and payer needs to communicate this information to IS department and billing vendors.
• Ability to work closely with others, and function as a team member.
• Ability to work with insurance companies to obtain or Evaluate pre certification/authorization for payment of procedures.
• Able to work in a fast pace, time constrained environment.
• Assertive without being abrasive.
• Basic working knowledge of ICD diagnosis, CPT or procedural Codes and how they are bundled or unbundled a plus.
• Business -like appearance.
• Data entry or typing experience. Thirty (30) wpm.
• Detail oriented.
• Good verbal communication skills.
• Knowledge of departmental charging a plus to recognize when claims are missing charges or are overcharged for compliant billing.
• Knowledge of registration data requirements a plus when correcting registration errors that hold up billing of claims.
• Knowledge of word processing and spreadsheets. Preferred qualifications includes MS Word and Excel.
• One (1) year experience in Medicaid billing in a hospital, clinic, or physician?s office setting preferred. Equivalent experience in other related areas, such as insurance billing,insurance company claims processing, or other heavy detail and heavy customer contact occupations may be substituted.
• Proficiency in spelling, business letter writing, and medical terminology.
• Working knowledge of internet and websites.

Definitions

• Team is responsible for day-to-day processing and analysis of Medicaid segment of accounts receivable, review of trial balances to identify and resolve problem areas includingformulation of action plans, prioritization of work, analysis of results, and customer service functions.

Contact With Others
Requires frequent contact with many persons at different levels inside and outside of the organization to carry out organization policies and programs and obtain willing acceptance, consent, or action.

Effect Of Error
Probable errors not easily detected and may adversely affect external as well as internal relationships and may result in major expenditures for equipment, materials, or procedures detrimental to the patient?s welfare or the organization?s interest. Work is subject to general review only and requires considerable accuracy and responsibility. Continually works with reports, records, plans, and programs of a major functional area of the organization where integrity is required to safeguard the organization?s position. Duties may involve the preparation of data on which the administration bases important decisions and are highly confidential.

Supervisory Responsibility
Exercises no supervision, work direction, or instruction of other employees or students

Mental Demands
Work involves a variety of problems in a general field, some of which are complex. Involves some independent judgment to decide what to do to assemble facts, determine variations from standard procedures, or plan other action to be taken to meet general objectives.

Physical Effort
Moderate physical effort - Lifts, carries, or handles lightweight (1 to 25 lbs.) materials or equipment for about half of the day. Very occasional physical effort with medium weight objects (25- 60 lbs.). Office or laboratory work requires close visual effort and concentration more than half of day. Works in reaching or strained positions for less than half of day.

Working Conditions
Generally pleasant working conditions/normal office environment.

Physical Aspects

Continually (at least once per day)

• Typing
• Hearing
• Visual
• Speaking

Occasionally (at least once a month)

• Manual Dexterity ? picking, pinching With fingers etc.
• Reaching ? below shoulder
• Color Vision
• Standing
• Walking
• Lifting up To 25 lbs.
• Handling ? seizing, holding, grasping
• Carrying