Part-Time, Days
DHR Health

POSITION SUMMARY:
This position is responsible for preparing accurate and compliant claims to be billed to Medicare, Medicaid and other insurance companies either electronic or paper and correcting any claim errors prior to claims submission and must also ensure that claims billed do not exceed the timely filing limits and re-submit any claim as necessary.

POSITION EDUCATION/QUALIFICATIONS:

• High School Diploma/GED is required
• One (1) year billing experience, or relevant education in claims billing and filing is required. Outpatient family practice setting preferred.
• Basic computer skills are required.
• Knowledge of healthcare reimbursement is preferred
• Good written and verbal communication skills are required
• Ability to read, write and speak English
• Ability to communicate clearly and concisely with all levels of Management

JOB KNOWLEDGE, SKILLS, AND EXPERIENCE:

• Communicates clearly and concisely and is able to work effectively with other employees, patients and external parties
• Establishes and maintains long-term customer relationships, building rapport with other department staff
• Demonstrates proficiency in Microsoft Office applications, be able to type at least 35 WPM, and good working knowledge of Excel is preferred
• Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly
• Requires reasoning ability, good independent judgment and working with frequent interruptions.
• Medical Terminology, ICD-10 CPT Codes, HCPCS Codes, and Diagnosis codes knowledge is preferred.
• Ability to use the internet to obtain information from Third Party Payers or other sources is required.

POSITION RESPONSIBILITIES:

• Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
• Demonstrates proficiency in billing claims to various insurances and follow-up of rejected claims on-line or through billing software; as billed or adjusted online biller will ensure to mimic changes on a HCFA 1500 copy on Relay (set to laser print)
• Ability to use the internet for Insurance web-portals, Availity and TMHP access for online submission and or corrections.
• Submits adjusted claims to Commercial, Medicare and Medicaid Managed through online automated system.
• Daily, works all identified billing edits through electronic billing system.
• Transmits all electronic claims to the billing vendor.
• Proficient in creating and reviewing Late Charge Adjustment reports
• Proficient in Interim Billing
• References updated ICD-10-CM, CPT, Modifiers and HCPCS Level II code books as needed.
• Works and follows up on the electronic rejection reports by correcting the UB-04/HCFA 1500 and resubmitting the claims daily.
• Proficient in printing out UB/HCFA files daily; and UB distribution
• Works the non-transmitted report by researching the error and resubmitting the corrected claims daily.
• Works re-bills requested by follow up staff through the electronic billing system daily
• Works on editing and preparing Secondary/Tertiary claims for either electronic or paper submissions, to include all necessary primary EOBs and or MRANs
• Ensures to bill all CSHCN claims via web-portal.
• Works the accepted and rejected reports from the billing vendor and documents on patient management in the appropriate account.
• Communicates billing issues with the supervisor/manager immediately.
• Responsible to place claims under appropriate Billing hold for designated department to complete the requests of clarification on diagnosis, CPT , HCPCS, or Modifier, etc
• Reviews late charges weekly, based on specific insurance plan, for rebilling and or adjustment under Late Charges; OBS adjustments for Medicaid/Medicaid Managed Care claims for over 48 hours
• Utilizes Paragon and Cerner when requesting additional information from other co-workers or departments
• Ensures that all pertinent account activity is documented 100% by entering the appropriate mnemonic in the notes tab via Paragon and Cerner as applicable
• Reads any updated, changes and corrections needed by the carrier.
• Proficient in accessing information needed to access medical records from Cerner system.
• Request copies of medical records from HIM for any paper records and or obtain consent forms for billing purposes
• Adheres to the Qa requirements process.
• Ensures patient confidentiality requirements are met in accordance with HIPAA policies and procedures.
• Other duties as assigned.