Responsible for billing, electronic claims submission, follow up and collections of patient accounts.
High school diploma, General Educational Development (GED) or equivalent required
Coursework in Coding, Billing or Healthcare Management normally acquired through enrollment in a secondary education institution or online classes through the American Heath Information Management Association (AHIMA) preferred.
Minimum of one (1) year prior experience in healthcare third party billing and/or claims processing preferred.
Prior exposure to UP04 and/or CMS1500 claim data normally acquired through work in a physician’s office or other healthcare setting preferred.
Skill in interpreting UB04 and/or CMS1500 claim data to be able to troubleshoot claim edits and resolve payer billing requirements both timely and accurately.
Ability to create and submit both original and corrected claims.
Ability to audit accounts and payer explanation of benefits (EOBs) to determine appropriate action.
Ability to use effective communication skills in order to handle patient inquires, attorneys, health system staff and payers on a professional level.
Knowledge and understanding of accounting and business principles to enable accurate auditing of patient accounts.
Ability to follow up with the 3rd party payers for claims and appeals submitted to ensure timely and accurate processing.
Ability to maintain a working knowledge of multiple system applications.
Light Work - Exerting up to 20 pounds of force.
Occasionally Performed (1%-33%):
Frequently Performed (34%-66%):
Constantly Performed (67%-100%):
Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)
Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)
Explosives (pressurized gas)
Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc)
Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)
Chemical agents (Toxic, Corrosive, Flammable, Latex)
Mechanical moving parts/vibrations
Note: Safety Officer can assist with identification of job hazards
Essential Job Functions
Essential Functions I
Electronic and Hardcopy Billing
All EDI and paper claims submitted are to be billed as needed following department and payer specific guidelines.
Obtains appropriate EOB's through use of health system resources.
Reviews Billing Scrubber Claim Detail Screens to ensure data is appropriate for claim submission.
Ensure that claim corrections identified in billing scrubber are appropriately updated and documented in Source System.
Prepares secondary and tertiary billings, manually and electronically on UB04's and/or 1500's for accurate reimbursement.
Submits adjusted UB04/837I and/or CMS1500/837P claims according to department and payer specific guidelines. Display Effective Communication Skills
Demonstrates active listening skills.
Notifies and keeps leads and supervisors informed on issues identified.
Follows telephone etiquette procedures set forth by the organization and/or individual department.
Professional/Courteous responses when communicating with customers, health system staff and management. Handling of Referrals
Timely and accurately handling of referrals, both regular and escalated priority from management, within department guidelines.
Documents clearly and appropriately all referrals (including patient inquiries) in the Source System when necessary.
If necessary, follows up with patients on final results of inquiry both timely and professionally. Notifies patient of final results of account handling in question. Knowledge of System Applications
Demonstrates ability to learn and maintain a working knowledge on all the current health system applications.
Identify/obtain/print medical records as necessary for resolution of denial or system edits according to department guidelines. Auditing of Patient Accounts
Understand accounting and business principles to accurately determine the remaining balance on a given encounter.
Upon accurately auditing encounter or visit, is able to understand and update proration to make sure dollars are allocated to the appropriate benefit orders if needed.
Leverages all needed resources to complete an audit of an account.
Documents audit finding and actions taken in Source System when necessary. Claim Follow Up with Third Party Payers
Full understanding of all necessary third party billing and follow up processes based on department specifications.
Full understanding of all necessary contract related requirements.
Leverages payer websites and necessary tools to streamline the follow up process.
Appropriate documentation in Source System when necessary.
Ability to interpret correspondence assigned for accurate handling. Special Projects and Tasks as Assigned
Completion of any assigned projects timely, accurately and to the specifications of leadership.
Ensure Daily/Weekly/Monthly assignments are handled accurately and timely. Maintaining Daily Workflow
Manages and maintains assigned workflow queues according to department guidelines.
Mail/Correspondence processed and handled following departmental guidelines.
Documents both timely and appropriately in Source System using proper documentation methods.
Fundamental understanding of different work item, state based and exception queues within the Patient Accounting System applications.
Essential Functions II
Participates in mandatory in-services and/or CE programs as mandated by policies and procedures/external agencies and as directed by management. Follows and understands the mission, vision, core values, Employee Standards of Behavior and company policies/procedures. Other duties as assigned.
Fremont Area Medical Center