Primarily responsible for reviewing and accurately billing complex, unresolved outpatient medical claims (i.e. surgery, interventional radiology, interventional cardiology, and surgical radiology procedures, etc.) for Medical Center and/or community hospitals.
Monitors status of all claims being reviewed within the department and ensures held claims are being processed timely and accurately.
Partners with customer service staff to analyze, review and resolve complex payer rejected claims.
Maintains in-depth knowledge of regulations and policies affecting the medical billing industry. Reviews and communicates regulatory changes to the appropriate entities.
Responsible for initiating process improvements with departments related to medical necessity and CCI requirements.
Identifies incorrect billing trends; notifies management of issues and provides staff education and training as needed.
Liaison with Health Information Management regarding coding questions and problems.
Reviews and analyzes inpatient claims.
Performs detailed compliance audits to validate regulatory compliance of data elements received from billing systems.
Performs billing and collection of specialty claims (i.e. Hemophilia, 1500 Urgent Care billing, Bariatric Surgery, Diaphragm Pacing claims, and Percutaneous Carotid Stenting claims). These claims require review and analysis to assure that they are submitted with the correct and necessary information,
Serves as a resource to co-workers for questions, and provides assistance with problem resolution.
Answers and researches coding questions that may be posed by different departments to assure that claims billed are reported correctly and are compliant.
Performs other related duties as assigned.
•High School diploma or GED required.
•Associate’s degree preferred.
Credentials, Licensure or Certification (i.e. RN, RRT):
• CPAM, CCS or RHIT preferred
Experience & Knowledge:
• Five plus years experience with hospital revenue accounting, billing, reimbursement and/or patient accounting required.
•Must be detail-oriented and organized, with good analytical and problem solving ability.
•Notable client service, communication, presentation and relationship building skills required.
•Ability to function independently and as a team player in a fast-paced environment required.
•Must have strong written and verbal communication skills.
Special Skills & Equipment Knowledge:
• Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e. printers, copy machine, FAX machine, etc.) required.
•Quadax and/or HDS experience preferred.
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