This position reports directly to the Patient Accounting Supervisor and is responsible for the billing of facility claims to various payers both electronically and via paper submission. This position ensures all bills are submitted daily to the correct entity and that any errors that may hit an edit are corrected prior to claims submission.
Essential Job Functions:
Access multiple billing systems daily to ensure all clean claims are submitted to the correct entity for timely payment. Those claims hitting an edit must be reviewed and follow-up done with the appropriate department to ensure resolution resulting in clean claim submission.
- Reviews claims daily in multiple billing systems to ensure claim accuracy prior to claim submission.
- Performs BTR reconciliation when necessary to ensure all claims have dropped in the appropriate system
- Splits charges between multiple lines when a zero charge is present on the claim
- Reviews the Payer matrix to ensure claims are routed to the appropriate payer.
- Ensure records are attached to the appropriate claims as required by the payer and sent certified mail.
- Prior to paper claim submission ensure appropriate address.
- Obtain the appropriate CMG code prior to submission of Rehab claims.
- Ensure the correct value code is present prior to secondary claim submission
- Review claims for invalid/missing modifiers, invalid number of units (MUE edits), invalid CPT code and date span errors as well as additional edits as required.
- Coordinates retrieval of pharmacy invoices for 340B billing prior to claim submission.
- Works electronic insurance rejects daily in order to retransmit with corrected insurance information / data
- Identify and notify responsible departments of issues pertaining to incorrect CPT or ICD-10 coding and obtain correct codes from the appropriate department
- Transmits bills electronically to all payers, reviews all paper claims prior to submission to ensure electronic transmission is not an option.
Additional Duties and Responsibilities:
- Works in collaboration with the collectors by reviewing accounts submitted 30+ days ago that have yet to have a payment posted and/or acknowledgement received. Also, will assist in documenting correspondence and/or pulling required documents as outlined within the correspondence.
- Works in collaboration with the Credit Analyst by assisting in the review of credit balances.
- May assist in patient calls as well as place follow-up calls to insurance carriers.
- Training of new hires as necessary to ensure an understanding of the billing system/overall processes
- Ensures that patient confidentiality is always protected, both audible and visible
- Ensures compliance with all medical practice regulations, such as, but not limited to HIPAA and OSHA
Safety and Infection Control Responsibilities
Responsible to maintain a safe and clean environment, including department/unit based safety and infection control requirements.
Qualifications: ESSENTIAL COMPETENCIES, KNOWLEDGE & EXPERIENCE
- High School Diploma or GED Required
- 3+ years of Acute Care Hospital billing experience, must include Medi-cal, Medicare and Commercial payers
- Ability to perform mathematical calculations, balance and reconcile figures.
- Must be able to read and write in English.
- Must have ability to demonstrate flexibility and prioritize work load.
- Knowledge of healthcare payor systems and benefits (Medi-cal, Medicare, HMO, PPO, Work Comp billing guidelines)
- Understanding of CPT, ICD10 and HCPCS codes
- Demonstrated knowledge of HIPAA rules and regulations
- Excellent oral and written communication skills; must be able to function in a team environment.
- Must possess knowledge of condition codes, value codes and modifiers.
- Computer skills including Microsoft Office; especially Word, Excel and Outlook
Each new hire candidate who is offered employment must pass a physical evaluation, urine drug screen and pre-employment background checks before starting work.