Billing Specialist (SETMA)
Responsible for posting, coding, and collection of receivables.
- Receives and organizes hospital census, charge sheets and other billing data to be coded and entered into the proper spreadsheet or EPM.
- Contacts various parties to request and/or obtain missing documentation and appropriate coding.
- Reviews and ensures that correct information/ documentation has been entered into the EPM, EMR and hospital, to be able to code the charges correctly before they are billed.
- Organizes, compiles and enters all assigned charges and/or payments, balances to the system, maintains spreadsheets and logs as applicable.
- Reviews all daily charges from the “interface” and corrects errors to ensure proper billing.
- Enters patient demographic information and charges into EPM. Files hard copy based on visit and information entered.
- Provides coding feedback to the medical providers regarding billing problems via e-mail.
- Attains proper documentation from the patient’s medical record and assures that all new or denied claims are corrected utilizing CPT-4 and ICD-9 codes to insure proper reimbursement.
- Reviews, copies and appeals denials as outlined in the Explanation of Benefits.
- Audits patient accounts and generates claims for billing secondary claims.
- Audits patient accounts to ensure that refunds and adjustments are properly done.
- Handles the “CBO front desk” collections and patients with billing enquiries.
- Research and contact various parties to obtain information to submit corrected data for re-billing. Such as researching addresses from returned mail, contacting the patient for correct billing information, calling hospitals and other agencies for proper documentation, etc.
- Timely communicates, verbal or written, with payers to expedite collections.
- Handles “Billing Phone” for all patient billing questions in a timely manner.
- Contacts patient to inform them of coverage of services and their responsibility prior to appointment date. (diabetes management, etc)
- Call insurance companies to verify insurance eligibility and coverage. Requests appropriate referrals when required by the insurance companies.
- Follows Universal Precaution Procedures while performing applicable duties.
- Complies with the facility privacy policies and procedures for the management of protected health information (PHI)
- Understands that ignoring situations where PHI may have been potentially compromised comes with legal ramifications to both the practice and myself.
- Utilizes appropriate Personal Protective Equipment in the performance of duties.
- Demonstrates knowledge of policies and procedures applicable to job position.
- Maintains computer skills, keeps up with coding and billing updates necessary to insure accuracy and efficiency in the performance of all assigned job duties.
- Adheres to infection control and safety policies, including education, reporting and practice implementation specific to job position.
- Helps to maintain the office area to reduce the risk of safety hazards and enhance general appearance.
- Multi task duties with attention to detail. This inc
- Protects and honors patient and co-worker confidentiality.
- Consistently adheres to Agency dress code.
- Work independently or as a “Team” and without direct supervision by prioritizing work and following through on duties.
- Meets attendance and punctuality expectations.
- Behavior toward coworkers, supervisors and patients consistently displays a courteous respectful attitude and promotes teamwork within the organization.
- Performs other duties as assigned by supervisor.
Education and/or Experience:
- Must have a high school diploma or the equivalent and may have two years of medical office experience.
- Must have at least one year of data entry experience and able to accurately and efficiently type 35 words per minute utilizing a Windows based computer software.
- Must be able to use a ten-key by touch.
- Must demonstrate appropriate verbal and written skills and ability to communicate with all ages in a professional manner.
- Must have working knowledge of CPT-4 and ICD-9 codes
Job Status: Full Time
Job Reference #: 3462