Summary of Essential Functions:
- Verifies and computes insurance claims, payments, refunds, adjustments, benefits, patient balances and appeals.
- Reviews and interprets billing regulatory issues and applies regulations in day to day billing practices.
- Prepares financial reports, productivity reports, graphs and worksheets.
- Keeps current with NCCI Edits and application of appropriate modifiers and reviews edits for all Billing Staff.
- Focuses on Medicare, Medicaid, and Tricare in aging categories 120 and over for resolution of problem accounts.
- Reviews Newsletters and publications regarding governmental claims processing guidelines and distributes applicable information to responsible parties for further education and implementation.
- Works with Director on identifying root causes for delayed reimbursement on outstanding claims.
- High school graduate or equivalent.
- Over 2 years and up to 4 years recent billing experience, all of which may be obtained through vocational school or related job experience.
- Must be able to communicate effectively in English, both verbally and in writing.
- Knowledgeable of HCFA and other regulatory billing requirements.
- Ability to use personal computer, including but not limited to Microsoft office and lotus notes.
- Ability to organize, make independent decisions, instruct, listen, display professionalism and adhere to confidentiality for employees and patients.
- Knowledge of revenue codes, HCPCS codes, CPT codes, and local codes.
- Ability to apply NCCI and OCE edits in daily processes of the department.
Duties and Responsibilities:
- Works outstanding governmental claims as assigned by manager.
- Reviews and ensures comprehension and application of data received via newsletters and workshops. Distributes applicable information to applicable personnel for further education and assists in any written implementation guidelines.
- Keeps current on NCCI rules and application of appropriate modifiers. Reviews Edits for billing staff and approves application appropriate changes as applicable.
- Serves as backup to verify 24/72 hour rule is applied according to policy and Hospital reporting records. Serves as backup in absence of Reimb Specialist for all assigned daily reports and billing edits. Also serves as a backup in managers absence.
- Reports unpaid delinquent claim findings to Director and reports on root causes for staff education and training .
- Serves on Sr.Staff Development Team to develop and maintain accuracy of the Billing Guidelines Procedure Book. Responsible for updating guidelines after Manager Approval of changes.
- efiling of insurance claims as required from follow up on unpaid claims. Ensures follow-up for final receipt of reimb on problem accounts.
- Compiles data to refile accurate insurance claims ensuring accuracy and identifying and correcting problems as well as reporting repetitious errors to Manager or Financial Analyst as applicable for education or system correction.
- Timely processes assigned aged claims to ensure resolution of problem accounts. Ensures accurate adjustments, current financial class and filing or billing of next carrier when working assigned claims. Properly notates patient accounts.
- Performs all other tasks/responsibilities as necessary.