Pre-Billing & Financial Liaison - Billing Specialist Sr

OB SUMMARY

Acts as a patient advocate when discussing outstanding balances to include third party payer options and Medicaid qualification process.

Analyze adverse billing, collections, and payer trends and report/present to management to include suggested solutions.

Assist with oversight and coordinating with staff for processing outstanding demographics, unbilled claims and incomplete demographic records.

Basic understanding of payer fee schedules and claim requirements to include facility contracts.

Categorize and quantify payer billing issues for resolution reporting to management.

Demonstrate ability to contact insurances and government agencies in order to obtain eligibility, to process authorizations or discuss benefits and billing requirements.

Demonstrate and maintain consistent customer focus in the face of adversity and change both internally and externally.

Demonstrate proficiency in GH Live, GE/Centricity and external software as required.

Demonstrates time management skills to support uneven volumes and monthly close requirements.

Demonstrates understanding of payer fee schedules, enrollment requirements along with PHI payer and facility contracts.

Demonstrates understanding of insurance types, financial classes for support of compliant billing .

Good working knowledge of HCPCS, CPT, ICD-9/ICD-10 codes, medical terminology and clinical documentation.

Handle patient calls in support of collections activities to include financial review for charity program, payment plans, negotiation of discounts and proper resolution of patient concerns.

Identify appropriate contacts and develop/maintain a professional relationship with all facilities and first responders in order to obtain demographic information for billing.

Identify clinical and dispatch document discrepancies per PHI policies in order to support compliant and accurate billing.

May assist with special projects related to payer issues or overall collection shortfalls.

Must demonstrate positive teaming, effective cooperation in all communication within established team and throughout the entire PFS department.

Notify clinical and dispatch personnel of any document discrepancies per PHI policies in order to support compliant and accurate billing.

Knowledge and ability to train in patient accounting functions, tools and processes applicable to medical billing and accounts receivable management.

May assist with special projects related to payer issues or overall collection shortfalls.

Monitor and track transports with incomplete demographics and/or documents to prioritize work throughout the team in order to maintain production standards.

Must demonstrate positive team building skills, effective cooperation in all communication within established team and throughout the entire PFS department.

Identify and notify clinical and dispatch personnel of any document discrepancies per PHI policies in order to support compliant and accurate billing.

Organize work through assigned queues to ensure all transports are billed accurately in a timely manner.

Participate in increasing responsibility through ongoing training and expansion of duties.

Perform, identify, collect and confirm insurance coverage to include obtaining prior authorization, third party liability and coordinator of benefits.

Performs in-depth account review for proper clinical charts, dispatch, facility for support of compliant billing.

Performs in-depth account review for proper field requirements for support of compliant billing.

Performs research for new payers and their compliant billing requirements.

Proficiency in Microsoft windows, Excel, and word. Proven ability to manage files and use all web-based tools available.

Provide leadership and to act as a resource for management to assist, train and provide support to the PFS Billing Staff

Represents PHI in a customer centered and compassionate manner when contacting patients and their families to obtain billing information.

Understand billing requirements and system requirements to bill all insurances in support of clean claims – electronic or paper.

Understand billing requirements for all payers and programs and participate in ensuring claims are accurate prior to submission.

Research, evaluate and interpret and payer specific billing policies, guidelines and statutory regulations for insurance and collection follow-up.

Supports and conducts training for PFS staff of new and established payers to include compliant billing requirements.

Take direction, coordinate projects and prioritize assignments on individual basis, as well as on a departmental/team level.

claims prior to submission for both electronic or paper claims

Complying with Company HS&E policy and procedures

Responsible for supporting company Safety Management Systems activities.

Understand and provide visible support of Destination Zero

Other duties and responsibilities as assigned.

SCHEDULE/LOCATION

5 & 2

Phoenix, AZ

QUALIFICATIONS/EXPERIENCE

Must have completed high school diploma (or GED equivalent) and have 5 plus years of previous experience in medical billing/collections with a progressive increase in complexity and responsibilities.

Must have knowledge of general office procedures using office equipment.

Must have PC skills and demonstrated proficiency in Microsoft Office Word, Excel and medical billing software.

Must have prior experience with email and using the web.

Must be able to pass a pre-placement drug test and background screen.

This position is designated Safety Sensitive for purposes of the Arizona Medical Marijuana Act.

SALARY

Regular pay scale applies

CORE COMPETENCIES:

Safe. We are absolute in our belief in the tenets of Destination Zero and that Zero is not only achievable, but the only acceptable outcome.

Efficient. We are focused on outcomes that are smart and responsible by making the best use of our resources to maximize overall productivity and achieve sustainable profitability as a high performing organization.

Quality. We are committed to ensuring excellent organizational performance which produces sustainable and reliable outcomes.

Service. We are dedicated to the service of our customers, our communities and each other.

BEHAVIORAL COMPETENCIES:

Drive & Energy – The ability to maintain a fast pace and continue to produce during exhausting circumstances.

Functional & Technical Expertise – Allows the individual to add organizational value through unique expertise and serve as a resource to the organization within his/her area of expertise

High Standards – Sets the stage for continuous improvements, the adoption of best practices and ultimately influences organizational standards.

Initiative – Takes a proactive approach and takes action without being prompted.

Integrity – Acts ethically and honestly and applies those standards of behavior to daily work activities.