Perform third party billing functions within established third party regulations and requirements. Responsible for all aspects of hospital/professional claim review and resolution.
Education:
High School Diploma or equivalent
Required Qualifications and Skills:
- Minimum of 2 years of third party hospital/physician billing experience
- Excellent communication skills
- Attain and maintain knowledge of billing/accounts receivable data processing procedures and systems for the purpose of performing daily routine data entry that is required for the billing process.
Preferred Qualifications and Skills:
- Ability to multi-task
- Work well in a team environment
- Medicare billing experience is preferred.
Essential Job Functions:
- Work assigned work queues daily/weekly to resolve claim denials in Cerner to ensure correct reimbursement and to avoid timely filing issues.
- Demonstrates computer literacy appropriately within the Cerner and SSI systems and Third Party Web Sites
- Examine incoming correspondence and review rejections to determine if further follow up is necessary. When trying to resolve claim denials or issues, identify if another department needs to be contacted to obtain correct charge/coding information.
- Processes third party refunds. Research and resolve misapplied monies that have been posted to accounts incorrectly.
- Ability to resolve problems with limited supervision. Focuses on quality improvements while problem solving
- Monitor follow up reports. Identify repeat claim errors by payer. Take appropriate action on delinquent accounts. Reports ongoing billing problems to the Patient Accounts Supervisor so a solution may be found and implemented to avoid further problems.
- Under the direct supervision of the Patient Accounts Supervisor and within established Hospital and departmental policies and procedures performs billing functions in order to bring accounts to resolution within a reasonable time frame.
- Use all resources, including guidebooks, payer websites, etc., to resolve any claim issues before reaching out to management.
AGE AND DIVERSITY RELATED CRITERIA: Consistently treats patients, colleagues and visitors with the dignity and respect, while being sensitive to the differing needs of all age groups, backgrounds, characteristics and cultures.
ABILITY TO FULFILL JOB EXPECTATIONS: Must have the ability to the perform essential functions of the position, including required work hours, locations and physical demands, without posing a direct threat to the health and safety of themselves or other individuals in the work place, and with or without reasonable accommodation.
PHYSICAL DEMANDS: Prolonged periods of sitting at a desk and prolonged periods of time performing computer work.
Sturdy Memorial Hospital is an equal employment opportunity employer. There is no discrimination because of race, color, creed, age, gender, sexual orientation, national origin, veteran status or disability.