Description

POSITION SUMMARY:

This position is responsible for business office activities which include patient billing, customer service, and transmission of all electronic claims several times a day, with the set up and monitoring of new insurance plans.

POSITION EDUCATION/QUALIFICATIONS:

• High School Diploma/GED is required
• Comprehensive knowledge of healthcare billing.
• Understands medical terminology.
• Excellent Customer Service
• Familiarity with EOB’s and RA’s.
• Must be able to multi-task, and work with frequent interruptions
• Good written and verbal communication skills are required
• Ability to read, write and speak English
• Ability to communicate clearly and concisely with all levels of management
• MD billing office experience required, hospital experience preferred.

JOB KNOWLEDGE/EXPERIENCE­:

• Communicates clearly and concisely; and is able to work effectively with other employees, patients and external parties
• Demonstrates proficiency in Microsoft Office applications, be able to type at least 35 WPM, and good working knowledge of Excel is required.
• Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly.
• Medical Terminology, ICD-9 Codes, CPT Codes, HCPCS code, Modifier knowledge is preferred.
• Requires reasoning ability, good independent judgment and working with frequent interruptions.
• Ability to use the internet to obtain information from Third Party Payers or other sources is required

POSITION RESPONSIBILITIES:

• Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
• Perform daily billing, including abstracts, interim bills, late charges, re-bills and split bills
• Transmits all claims worked by billers to all insurance carriers three times a day
• Submits professional 1500 claims as needed
• Works claims that have been placed on hold to ensure bills are released timely.
• Assist patients with questions and concerns regarding the billing of their accounts.
• Downloads and posts the electronic remit acknowledgement reports.
• Works the exclusion and rejection reports from Claims Administrator and makes any needed corrections, re-bill claims and balances daily billing
• Serves as a resource for billers, collectors, customer service, appeals staff and other departments.
• Monitors billing not imported report
• Monitors MD’s with no NPI numbers and locates them in order to update system for billing compliance
• Monitors Rehab, Oncology billing report and outstanding billing report
• Monitors billing edits and releases and makes updates as needed.
• Responds to all mail, email and phone calls in a timely manner.
• Completes provider applications for payers to set up for electronic billing and payments.
• Create I-Plans in Paragon and Claims Administrator as needed.
• Opens tickets with McKesson for issues with Claims administrator and follow up to resolution
• Ensures patient confidentiality requirements are met in accordance with HIPAA/PHI policies and procedures.
• Other duties and special projects as needed.

LINES OF REPSONSIBILITES:

CFO …. Director …. Manager ….. Supervisor