PURPOSE OF THIS POSITION This position is responsible
for all medical claims including pre-billing and follow up
activities for delayed claims by ensuring, through various
activities, that claims are clean and should be paid promptly by
insurers without requiring further intervention. This staff member
performs all pre-claim submission activities, including verifying
existing information is accurate, determining when additional data
is needed, and collecting necessary details to ensure claims are
complete. Additionally, this individual follows departmental
productivity and quality control measures that support the
organization’s operational goals. This position promotes revenue
integrity and accurate reimbursement for the organization by
ensuring timely and accurate billing, timely payer follow-up
activities and collection of accounts. JOB DUTIES/RESPONSIBILITIES
Duty 1: Maintains a thorough understanding and education of federal
and state regulations and payer specific policies and requirements
to promote compliant claims submission practices. Adheres to HIPAA
related privacy, security and transaction & code set
regulations in compliance with the federal guidelines. Accurately
documents all account activity. Duty 2: Accurately and efficiently
works daily electronic billing file through the organization’s
billing system by resolving all necessary corrections with valid
resolution to obtain a clean first-time reimbursement. Duty 3:
Corrects all claims issues prior to submission which may be, but
are not limited to, quality audits of patient demographic
information and insurance eligibility, cross referencing with
previous services, verifying payer authorizations, identifies and
bills missing and late charges and corrects all necessary
discrepancies. Submits required clinical documentation for
submission with claims and collaborates with additional departments
of the hospital to ensure claims are ready for billing and
first-time payment. Duty 4: Educates staff in other departments
when existing documentation is not sufficient for billing. Duty 5:
Prepares and submits manual insurance claims to payers who do not
accept electronic claims or who require special handling. Duty 6:
Monitors and analyzes error reports to identify significant trends,
process improvements or efficiencies and increase accuracy to
achieve the overall goals of the department and organization. Duty
7: Monitors outstanding billing holds, escalates accounts as
necessary, accurately works delayed claims and reports any trends,
issues or findings to supervisor. Duty 8: Observes best practice
billing, follow up and customer service activities and reports any
suspected compliance issues to supervisor. Duty 9: Identifies
high-risk accounts, prioritizes follow up efforts, efficiently
contacts various insurance payors to determine reasons for
outstanding claims and proactively communicates to facilitate
timely payment of submitted claims. Duty 10: Investigates any
over/underpayments and communicates with payers when necessary to
rectify any pending or delayed claims. Duty 11: Proactively
recognizes and rectifies any issues to prevent future insurance
payor audits and communicates findings promptly to leadership. Duty
12: Regularly attends and actively participates in staff meetings,
training and continuing education that aligns with recognized
improvement opportunities, payer policies and procedures and
ensures to maintain up to date certifications. Duty 13: The above
duties reflect the general duties considered necessary to describe
the principal functions of the job as identified and should not be
considered a detailed description of all the work requirements that
may be inherent to the position. REQUIRED QUALIFICATIONS High
school graduate or GED equivalent CPFSS certifications required
within 12 months of hire (PRN status does not require
certification) Familiarity with medical terminology and an
understanding of HIPAA requirements Ability to perform project work
which may require independent work or collaboration with others
Proficient in Microsoft Office Programs, especially Excel Ability
to manage multiple tasks and complex issues with excellent time
management & organizational skills Demonstrated problem solving
skills with excellent self-direction and creative solutions for
operational efficiencies Adapts positively to changes in the
working setting with ease A valid driver's license is required (if
you do not have a valid Ohio driver’s license you must obtain one
within 30 days of your residency in the state). You must also meet
BVHS's company fleet policy and insurance company requirements, and
any other requirements that may be required to operate a vehicle.
Individual must be able to demonstrate the knowledge and skills
necessary to provide care appropriate to the age of the patient
served on his/her assigned unit/department. The individual must
demonstrate knowledge of the principles of growth and development
over the life span and possess the ability to assess data
reflective of the patient status. Must be able to interpret the
appropriate information needed to identify each patient’s
requirements relative to their age-specific needs and to provide
the care needed as described in the area’s policies and procedures
PREFERRED QUALIFICATIONS Associate’s degree, CPC certification or
2-3 years of experience in medical billing, coding or other revenue
cycle functions preferred Conversant with various code sets (e.g.,
ICD-10, CPT, HCPCS, Modifiers, etc.) Familiarity with data elements
on standard billing forms (e.g., CMS-1500) PHYSICAL DEMANDS This
position requires a full range of body motion with intermittent
activities in walking, lifting, bending, squatting, climbing,
kneeling, and twisting. The associate will be required to sit for
five hours a day. The individual must be able to lift ten to twenty
pounds and reach work above the shoulders. This position requires
corrected vision and hearing in the normal range. The individual
must have excellent eye-hand coordination and verbal communication
skills to perform daily tasks.
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