Job Description

Job Description

Job Description

Position Summary:

Responsible and accountable directly to the Revenue Cycle Director for the timely and accurate billing and follow-up processes for all payers. Follows guidelines as established by management in accordance with UB04 and HCFA1500 billing guidelines. Insures accounts are billed appropriately, using appropriate billing regulations. Follows up on denied and/or un-paid claims to satisfy account resolution.

Job Activities:

Understands and follows Missouri Delta Medical Center’s Mission, Vision and Values document, as well as the Conduct Rules document. Greets all guests utilizing excellent guest relation techniques. Displays respect and dignity to patients, visitors and staff. Upholds hospital policies and maintains a code of confidentiality on all patient information.

Performs appropriately in difficult situations by remaining calm, notifying appropriate personnel and initiating appropriate action for patient accounts receivable resolutions.

Assists in processing insurance remittance advices when needed to assure payments and contractual allowances are properly posted. Demonstrates proficiency in applying proper and effective billing procedures techniques to perform job functions.

Interprets Medicare or Medicaid requirements and managed care provisions necessary to obtain proper payments/contractual adjustments in compliance with billing regulations. Investigates potential charge master problems and/or revisions and forwards recommendations to Director for updates according to CPT/HCPC and billing edits. Insures patients are only billed for those charges or portion of billing deemed their responsibility by their insurance(s).

Investigates denials/edits on Medicare’s/Medicaid’s remote billing system or on any managed care payer website for claim resolution.

Analyzes aging reports, work lists, etc. for claim resolution. Identifies potential filing problems and takes appropriate action on unpaid claims. Follows-up on unpaid claims to insure all collection efforts are met prior to determining account balance is self pay portion.

Coordinates with outside business office vendors for any additional information needed to accurately bill for services. Acts as the liaison between Case management and HIM staff, as needed, for accounts placed at outside extended billing office.

Accurately documents patient telephone calls, patient inquiries, collection agency and insurance inquiries and other account follow-up information in hospital information system. Scans any necessary support documentation into the hospital’s patient accounting system.

Analyzes aging reports, work lists, etc. for claim resolution. Identifies potential filing problems and takes appropriate action on unpaid claims.

Participates in departmental training, team building activities, in-services and education presentations as requested. Assists in new employee training as assigned. Must complete annual skills testing to insure knowledge is complete to perform assigned duties.

Performs other duties as assigned.

Position Qualifications:

High School graduate.

Two years’ experience working in receivables management and healthcare billing preferred.

Displays a positive attitude. Handles conflict situations effectively.

Ability to read, interpret and act upon new regulations related to governmental billing.

Must be able to take initiative and responsibility for actions.

Excellent verbal and written communication skills.

Must have excellent attendance record.

Visual and hearing acuity pertinent to communication with patients, visitors and staff.

Able to perform assigned duties independently without direct supervision. Able to handle multiple tasks in a fast paced environment.

Minimal knowledge of ICD and CPT coding helpful.

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