EDUCATIONAL REQUIREMENTS

• High School Diploma or equivalent.
• Minimum of 2 years of recent billing experience which may be obtained through vocational school and related job experience.
• Must be able to communicate effectively in English, both verbally and in writing.

CERTIFICATION/KNOWLEDGE/SKILLS/ABILITIES

• Knowledgeable of regulatory billing requirements.
• Ability to interpret medical record, concentrate and maintain accuracy in spite of interruptions.
• Initiative to use standard office equipment and to maintain confidentiality with regard to aspects of work.
• Knowledge of medical terminology, anatomy, coding/classification systems, reimbursement principles, and coding software preferred.
• Ability to use personal computer, including but not limited to Microsoft office and lotus notes.
• Ability to organize and 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.
• Willing to learn and effectively maintain electronic medical records.

PHYSICAL REQUIREMENTS

• Ability to work under pressure and stress.
• Requires eye-hand coordination and manual dexterity.
• Requires corrective vision and hearing to normal range.
• Must distinguish between numbers and symbols.

SUMMARY OF ESSENTIAL FUNCTIONS

• Verification of patient’s insurance coverage and determines any payment due prior to patient’s visit. Verifies and computes insurance claims, payments, refunds, adjustments, benefits, patient balances and appeals.
• Processes, reviews, abstracts, codes and indexes diseases, operations, treatments on outpatient diagnostic and/or medical records, ensuring governmental compliance on regulatory issues.
• Reviews and interprets billing regulatory issues and applies regulations in day to day billing practices.
• Prepares financial reports, productivity reports, graphs and worksheets.

DUTIES AND RESPONSIBILITIES

• Process any questionable amounts due with the Business Office Manager according to facility Policy and Procedures. In addition to: communicate with front office staff accounts needing cash collection, and work with Business Office staff to ensure that departmental goals are met.
• Displays understanding of billing practices that are accurate and effective. Complies data to file accurate insurance claims ensuring accuracy and identifying and correcting problems as well as reporting repetitious errors to the coordinator as applicable for education or system corrections. Completes billing process including getting charge information from physicians.
• Codes information about procedures and diagnosis on charges. Includes: Accurately keys charge information into on-line entry program and produces billing. Process tracers in a timely manner to ensure prompt insurance reimbursements and verifies accurate payments and applicable adjustments are posted. Ensures accurate current financial class and filing or billing of next carrier.
• Identifies and resolves patient billing complaints.
• Post insurance and personal payments to accounts using correct journal codes.
• Reviews all diagnoses according to ICD-10-CM and CPT-4 coding classification systems and regulatory guidelines. Maintain a 95% or higher quality rating.
• Monitors private pay patient accounts for delinquency to ensure a less than 10% impact on overall aging, not including any payment plans authorized by physician’s office.
• Performs various collection actions including contacting patients by phone and resubmitting claims to third party payers. Follows clinic collection policy guidelines and participates with other staff to follow up on accounts until no balance or turned over to collection agency or attorney via clinic Credit and Collection Policy. Uses collection management reports from electronic claims filing vendor to keep accounts receivable current.
• Answers inquiries and correspondence from patients and insurance companies. Assists with processes or problems associated with vendor(s) for electronic claims submission and accurately maintains electronic claims file maintenance. Helps to develop and maintain accuracy of the department Billing Guidelines Procedure Book.
• Performs insurance verification for Medicare & Medicaid patients.
• Also makes payment arrangements with Medicare patients resulting in increased revenue & a reduction in claim denials.
• Schedules patients into Advantx billing system.
• Codes patient accounts & prepares claims for both electronic & paper billing.
• Provides coverage for front desk/reception when needed.
• Answers majority of incoming billing calls.
• Performs claims follow-up & appeals.
• Discusses coding issues with physicians & physicians’ offices.
• Verifies pre-authorizations daily & follows up for missing authorizations.
• Posts payments into Advantx Billing System & Clearwave Registration System.
• Electronic Medical Record Software (Provation) upgrades. Checks with vendor website for upcoming upgrades & coordinates with IT department.
• Scheduling, Billing, Collecting Software (Source Medical –Advantx) upgrades. Checks with vendor website for upcoming upgrades & coordinates with IT department.
• Clearwave Registration System-Super User
• Clearwave is a kiosk & mobile registration (check-in) system, it provides insurance verification, mobile pre-check & patient payment options.
• Track financial data from Clearwave to show valuable financial information for reporting to the WFEC Board regarding upfront collections. Update spreadsheet daily & share with management weekly.
• Develop System for managing supply orders for WFEC.
• Coordinates with clinical staff for continuity of supply chain for WFEC.
• Performs all other tasks/responsibilities as necessary.
  Job Identification
  11109
  Job Category