Job Summary: Responsible for all aspects of hospital and professional billing activities. Maintains familiarity with all rules and regulations concerning governmental billing procedures. Communicates and interacts with insurance companies, physicians, patients, internal and external staff to provide effective customer service in response to inquiries related to billing issues.
Key Responsibilities:
1. Performs a variety of complex activities involving the processing of governmental claims.
2. Coordinates the collection of data from point of origin; participates in the preprocessing of data to locate missing information and make corrections as necessary.
3. Ensures all information on the billing form is accurate and makes appropriate corrections according to policies and procedures.
4. Coordinates with internal and external staff any billing issues ensuring these issues are resolved timely.
5. Monitors and evaluates consistent billing issues and trends, referring results and recommendations to supervisor or manager.
6. Attends governmental payer seminars and utilizes other resources to keep abreast of all payer and intermediary billing requirements.
7. Continuously research, monitor, and implement payer regulations and guidelines related to the filing of insurance claims.
8. Communicates with insurance companies, physicians, and patients to provide effective customer service in response to billing related issues.
9. Works with management in the maintenance, upkeep, and distribution of billing policies, procedures and guidelines.
10. Maintains familiarity and competence in the use of the billing and accounting systems.
11. Has comprehensive knowledge of UB, HCFA, HCPCS and related forms for billing purposes.
12. Basic knowledge of CPT/ICD9 coding and Medical Terminology as pertains to billing and reimbursement methodology.
13. Basic comprehension of EOB; UB usage including analysis of balances; other payer issues; third party liability; basic financial classes.
14. Shows willingness to enhance skill sets and accept cross training to meet global corporate needs.
Essentials:
Medicare
1. Must have detailed knowledge and understanding of Medicare remote system (DDE), including HIQA.
2. Must have experience working in the Medicare remote system (DDE), including RTP, keying a claim, and filing an adjusted/void claim.
3. Must be familiar with Medicare edits, including CCI and MUE’s.
4. Must have knowledge of Medicare guidelines and have the ability to research via Medicare resources such as CMS website, MLN, and LMRPs.
5. Must be familiar with payment methodology, including fee schedules, OPPS, DRG, and MSDRG.
6. Must be familiar with charges or procedures which can be carved out of an inpatient claim and billed separately to achieve optimal reimbursement.
Medicaid
1. Must have extensive knowledge of current billing guidelines for the Louisiana Medicaid program.
2. Must be familiar with the Louisiana Medicaid website and all of the resources available on it.
Additional Functions:
1. Ensures strict confidentiality of patient medical and financial records, in
compliance with HIPAA guidelines.
2. Follows established departmental policies, procedures, and continuous
quality improvement objectives.
3. Demonstrates knowledge and understanding of organizational
policies, procedures, and systems.
4. Work on special projects as directed by Patient Financial Services Manager or Supervisors
Customer Service:
1. Create a Positive First Impression
- Be Courteous and Compassionate at All Times
- Professional Image-Always Dresses Professionally
2. Anticipate the needs of the Customer
- Communication
- Utilization of Problem Solving Skills and Initiative
3. Respect Patients, Staff and Customers
- Respect the time of Others-Attendance and Punctuality
- Respect the Privacy of the Customer and the Confidentially of Records
4. Efficient Delivery of Service
- Minimize Customer Waiting by Providing Timely Service
- Financial and Resource Management
Qualifications:
EDUCATION, EXPERIENCE, AND TRAINING QUALIFICATIONS:
High School diploma or equivalent
Minimum of 1-2 years experience in filing hospital and professional claims.
Familiarity and competence on one or more billing (Preferably Premis) and patient accounting systems.
Knowledge of basic medical terminology
Demonstrated knowledge of all types of governmental insurance including Medicare and Medicaid is required.
LICENSURE/CERTIFICATIONS: AAHAM Certification preferred but not required.
OTHER SKILLS AND ABILITIES QUALIFICATIONS:
Ability to communicate effectively, both orally and in writing
Ability to work effectively with other employees, patients, and external parties
Perform basic mathematical calculation, balance and reconcile figures
Basic data entry and/or word processing skills.