Hospital Biller
: Job Details :

Job Description Under general supervision performs daily reviews, audits, and corrections to third party claims as necessary to ensure timely payment and reimbursement to HMC. Performs follow up as needed on submitted claims to determine cause of delayed payment and takes all necessary actions to resolve. Acts as a liaison between patients, third party payers, physicians, clinics, departments and the Medical Center in regard to the resolution of any billing related concerns. Participates in quality assessment and continuous quality improvement activities. Complies with all appropriate safety and infection control standards. Performs all job duties and responsibilities in a courteous and customer-focused manner according to the Hurley Family Standards of Behavior. Works under the direction of a departmental director or designee who reviews work for accuracy and conformance to standard procedures. Responsibilities

Reviews all billings for accuracy and completeness. Checks and verifies all third party identification numbers, diagnoses (ICD9/10), and procedural codes (CPT / HCPCS), modifiers, charges, chart documentation, financial class, insurance proration, etc. using resources such as CCI, LCD/NCD, or other carrier edits. Rebills third party payers and / or patients.

Communicates as necessary with patients and / or guarantors via mail, email, and / or telephone to promote timely resolution of third party claims in order to minimize unnecessary customer / patient involvement in the billing / reimbursement process.

Contacts appropriate Medical Center departments, physicians, organizations, and eligibility systems to acquire necessary information for patient / insurance billings and reimbursement. Performs appropriate and timely follow up to acquire missing/necessary information to perform billing.

Performs daily tasks using prescribed priority / workflows (i.e. daily claims, front-end rejections, denial work queues, follow-up work queues, etc.). Utilizes appropriate systems for both claim processing and follow up activities. Works to maintain a current status of assigned work queues.

Documents via system account activities, manual notes, and / or smart text options in order to record the accurate, timely action taken to resolve outstanding balances, denials, and /or other billing issues. Documentation must support account follow-up including, but not limited to financial class changes, statement processing, transactions, account adjustments, claim corrections, patient interactions, etc.

Reviews, investigates, and corrects rejected claims. Reviews account credits and resolves by either submitting refund requests, adjustments, and / or adjustment/replacement claims. Rebills third party payer or patient or notifies management of problem.

Acts as liaison among patients, third party payers, and Medical Center with regard to billing issues. May answer telephone inquiries related to outstanding receivables. Interacts as necessary with internal and external departments to assist in the resolution of billing related inquiries or questions. Interacts as necessary with Financial Customer Service Specialist Team. Escalates billing issues to management timely.

Performs updates to patient information including, but not limited to registration, demographic, authorization, and insurance information as appropriate and necessary. May perform updates and communicate issues with authorizations.

Performs necessary clerical tasks to expedite preparation and processing of billings to all applicable third party payers.

Under direction of supervisor, performs advanced assignments such as training, special studies, and participating in job shadowing.

Performs other related duties as required. Utilizes new improvements and/or technologies that relate to job assignment.

Qualifications

Education equivalent to graduation from high school.

Six (6) months of UB-04 billing experience (e.g., hospital facility billing,) or successful completion of a coding and billing program from an accredited college or university including each of the following: CPT coding, ICD coding, medical terminology, anatomy, and UB-04 billing.

Working knowledge of inpatient and outpatient billing procedures for third party carriers.

Knowledge of medical terminology and procedures.

Ability to use a computer, calculator, and other standard office equipment.

Ability to communicate effectively both orally and in writing.

Ability to conform to departmental performance standards.

Ability to establish and maintain effective working relationships with superiors, co-workers, other Medical Center employees, patients, third party payers, and the general public.