These duties and responsibilities described below represent the general tasks performed on a daily basis; other tasks may be assigned.
- Submit Inpatient/Outpatient electronic and paper claims (UB-04 and 1500) to the appropriate government and non-government payers.
- Understand how to resolve Billing errors and/or warnings that are identified in the Patient Accounting and Billing System.
- Keep abreast of payer-specific and government requirements and regulations.
- Ensures claim information is complete and accurate in order to accelerate cash collections.
- Analyze information contained within the Patient Accounting and Billing system to make decisions on how to proceed with the billing of an account.
- Processes rejections by correcting any billing error and resubmitting claims to government and non-government payers.
- Place unbillable claims on hold and properly communicate to various Hospital departments the information needed to accurately bill.
- Process late charge claims in the event that charges are not entered in a timely fashion by Hospital Departments.
- Submit corrected claims in the event that the original claim information has changed for various reasons.
- Perform the billing of complex scenarios such as interim, self-audit, combined, and split billing etc.
- Limit the number of unreleased claims by reviewing all imported claims and either billing or holding the claim for further review.
- Meet Billing productivity and quality requirements as developed by Leadership.
- Measured on high production levels, quality of work output, in compliance with established CRH's policy and standards.
- Record or generate revenue by gathering and processing information that impacts the patient revenue process.
- Review patient financial records and/or claims prior to submission to ensure payer-specific requirements are met.
Education and Experience
Minimum Required Education: High school diploma or equivalent
Preferred Education: College courses or associate's degree
Experience: 3+ years as a Hospital Biller or Follow-up representative preferred