SUMMARY

Performs third party billing for non-governmental third-party payers including traditional commercial insurance carriers, Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), EPO's, International Payers, Auto Liability and other Liability carriers, and all other non-governmental third-party payers. Duties include billing and ensuring claims go out on a timely manner to the appropriate payers.

REQUIREMENTS

RESPONSIBILITIES AND DUTIES:

• Responsible for ensuring timely submission of non-governmental claims in the billing editor. On a daily basis prepares and submits primary and secondary claims using the billing editor software to submit claims electronically or hardcopy, ensuring all edits are worked in a compliant manner based on directives given by management. Able to prepare and submit complex claims including split bills, interim bills, benefits exhaustion, etc.
• Monitors billing editor for correct claim edits and reports findings to management to make edit corrections.
• Shows proficiency in the ability to reconcile complex accounts, i.e. split payments, interim claims, benefits exhaustion, etc..
• Ensures all charge and coding related issues are clearly identified and entered in the HIM/Charge audit spreadsheet for clarification and resolution. Follows up to ensure timely response from others and ultimate resolutions.
• Identifies payer trends and reports to management providing input on appropriate steps to take.
• Maintains productivity levels within guidelines established by management. Receives an at or above team average productivity score
• Documentation. Documents clearly and succinctly in account notes all action taken on account, i.e., phone call numbers, representatives spoken to, corrective action taken, referrals made and specific claim submission details as appropriate.
• Performs duties with little or no errors. Remains at or above team average quality of work errors.
• Reviews 72 hour report to capture possible overlap issues prior to the claim being billed out
• Work rejected claims on the billing software on daily basis
• Completes Late Charge report accordingly
• Other duties as assigned.

EDUCATION & EXPERIENCE REQUIREMENTS:

• HS Some college preferred.
• Minimum 2 years’ experience in a hospital setting.

SKILLS & ABILITIES REQUIREMENTS:

• Knowledge of CPT, HCPC’s, HIPAA, UB04, Compliance and Regulatory issues.
• Knowledge of billing systems and software applications

PHYSICAL REQUIREMENTS:

• Body Positions: Sitting and standing for prolonged periods.

• Body Movements: Arm and hand dexterity.

• Body Senses: Must have command of close and distant sight, color perception and hearing.

• Strength: Ability to lift and move up to 25-pounds.