Billing / Coding Specialist

JOB SUMMARY:

· Responsible for billing patients, processing third party payer claims, i.e., Insurance, Medicare, Medicaid, Worker’s Compensation and other government assisted programs.

· Processing all correspondence and collections.

· Completes medical liens and bankruptcies.

· Processing secondary claims, answer telephone, insurance follow-up.

· Performance of job duties is done to meet or exceed expectations of Productivity Achievement, Accountability, Customer Service, including customer’s rights, privacy and confidentiality.

PREVIOUS EXPERIENCE NEEDED:

· Computer knowledge, accounting, business office machines.

· Knowledge of insurance and CPT/HCPCS’s coding helpful.

· Knowledge of credit and collection practices, CMS and third-party regulations helpful.

TRAINING & EDUCATION NEEDED:

· High school graduate with courses in business, computers, and accounting preferred.

· Hospital or medical-related experience preferred.

· Some college is helpful.

FUNCTIONAL REQUIREMENTS:

KEY: Infrequent (1-3 times per week)

Occasional (1-3 hours per day or <33%)

Frequent (3-7 hours per day or 33-66%)

Constant (7 or more hours per day or >66%)

· Lifting:

Must be able to lift 20 lbs from floor to waist on occasional basis.

Must be able to push or pull 50 lbs on floor.

· Standing/Walking/Sitting:

Must be able to sit from 5-8 hours

Must be able to walk/stand for 1 hour intermittently

· Lower Extremity:

Must be able to squat on occasional basis.

· Upper Extremity:

Must be able to grip/grasp/pinch of paper/secretarial equipment on frequent basis.

· Equipment:

Must be able to use computer and perform keyboarding on constant basis. View CRT’s on a

constant basis.

· Able to communicate (oral/written) in the English language.

JOB DUTIES:

· Accurately process insurance and patient bills on a timely basis.

· Accurately reviews all adjustments for Medicaid, Medicare, Worker’s Compensation, PPO discounts and others to ensure accuracy.

· Audits the insurance card information to ensure accuracy prior to billing and check for missing or incorrect information.

· Performs follow up on unpaid claims, files medical liens, estate demands, and bankruptcies as needed.

· Utilizes all available tools to manage accounts receivable efficiently including but not limited to:

- Collection Letters

- Aging Reports

- Payer websites for eligibility and claim status and other on-line websites

- CSNAP Medicare

- 3M Coder

- All available resources for billing/coding such as ICD and CPT books

- WORD

- EXCEL

- Internet – Insurance & Medicare Websites

· Accurately prepares the export function for claims to automatically export to the Clearinghouse for transmission.

· Accurately maintains all claims to pass edits for electronic filing and transmits on a daily basis.

· Efficiently collects payments daily and refers delinquent accounts for collection.

· Reviews all credit balances and makes adjustments or refunds as appropriate on a bi-monthly basis.

· Monthly receipts all reimbursement from collection agency, ARL, and completes necessary report.

· Consistently answers telephone calls and correspondence concerning patient billing in a professional, customer friendly and reasonable time.

· Complies with hospital/departmental norms for beaks and meals, ensure that the department is adequately staffed.

· Schedule patient appointments.

· Assist as needed with Clinic Receptionist duties.

· Must be detail oriented and have good organization skills.

· Complies with Attendance Management Policy in regards to attendance and timeliness, understanding the expectation of maintaining an absence percentage of 3% or less.

· Performs other duties as assigned by person in charge.