Electronic Biller, Patient Accounts Receivable

Electronic Biller, Patient Accounts Receivable

40 hours per week, day shift

Job Summary: Responsible for transmitting both primary and secondary claims daily. Reviews edits for accuracy and makes necessary corrections. Works with billing vendor to implement and/or revise edits in order to file compliant claims to all payers. Utilizes automated work lists within various software packages.

Education Degree/Diploma Obtained Program of Study Required/Preferred: High School Diploma or GED General Studies Required Certifications and Licensures Credential Required/Preferred None N/A

Experience # of Years Type of Experience Required/Preferred: 2+ Healthcare Industry Billing and/or Follow Up Required

Additional Knowledge, Skills, and Abilities:

• Must possess professional communication and analytical skills.
• Must be proficient with excel; updating spreadsheets, saving files, attaching files, etc.
• Working knowledge of keyboarding skills and Windows environment.
• Familiar with medical terminology, ICD-9 CM and CPT coding.
• Detail oriented with the ability to multitask and prioritize daily activities.
• Ability to use independent judgment to reach appropriate decisions.
• Must be knowledgeable of coding and billing regulations in order to avoid denials and/or audits from payers with an emphasis on Medicare and Medicaid regulations due to potential RAC and/or OIG Audits.
• Willingness to take ownership of processes to ensure complete account resolution.

Job Specific Duties:

• Electronic Billing Performs electronic billing functions with accuracy and efficiency to prevent backlogs and promote cash flow.
• Reviews confirmation reports to ensure all claims received by clearinghouse and/or payer and identify rejections.
• Prioritizes workload by age and dollar to ensure timely filing occurs.
• Maintains a weekly billing report on excel spreadsheet and daily spreadsheet of claims held.
• Systems & Supplies Identifies system issues, perform software updates, Support Requests (SSRs) from billing vendor.
• Claims Processing Makes corrections to accounts.
• Reviews and manages accounts.
• Reviews/processes accounts with late charges.
• Processes accounts with Patient Type changes after billing and ensures corrected claims are filed.
• Works Referral List daily in order to maintain patient satisfaction and positive cash flow.
• Reviews/resolves Medicare/Medicaid claims, reviewing claims to determine whether to file an adjustment claim.
• Medicare FISS System Resolves Return to Provider (RTP) claims in FISS/SSI Claims Status module.
• Must be proficient in FISS system in order to file A/B Rebill claims, determine whether to file adjustment vs new claim, determine whether to combine claims, etc.
• Reports Works with billing reports daily in order to reduce claim denials/rejections.
• Completes weekly productivity reports and meets productivity standards as shown on report.
• Documentation Enters detailed notes on accounts, updating Financial Class, Schedule, and transfer of money to correct insurance.
• Training Assists with the training and education of new and existing employees regarding with electronic filing related tasks.
• Professionalism Upholds a professional working relationship at all times and adheres to department rules.
• Practices teamwork and adheres to Standards of Behavior.
Other Duties Performs other duties as assigned by management.

WFBH Employee Standards

Communication: Uses appropriate methods to clearly convey information to others in an engaging way, which helps others understand and retain the message.

Collaboration: Works with others respectfully and openly; provides help to achieve shared goals.

Service: Uses appropriate methods to clearly convey information to others in an engaging way, which helps others understand and retain the message.

Safety: Meets or exceeds patient and employee safety requirements while promoting and achieving quality outcomes.

Accountability: Takes ownership for goals and outcomes; effectively and efficiently uses available resources to successfully complete tasks.

Improvement: Identifies opportunities and takes action to continuously improve processes. Maintains effectiveness and flexibility during change.

Workplace Requirements Employee Health: Complies with all required employee health programs including annual tuberculin testing and other applicable screening, testing and vaccinations.

Credentials: Maintains current licensures, certifications and/or registrations (if applicable for the position).

Job Competency: Complies with requirements for job specific competency testing and demonstrates and communicates proficiency in skills required (if applicable to position).

Corporate Compliance: Adheres to and understands the Health System's Corporate Compliance Plan as evidenced by timely participation in required training (including annual testing) and 100% compliance with the Corporate Compliance Code of Conduct.

Safety: Adheres to and understands the Health System's Environment of Care Plan as evidenced by timely participation in required training (including annual safety testing).

HIPAA: Adheres to and understands the Health System's HIPAA Compliance Plan as evidenced by timely participation in required training (including annual HIPAA testing).

Education: Attends all required educational programs (including General Orientation, and departmental or job specific required programs).

Physical and Behavioral Requirements

• Occasional stooping, standing, walking, kneeling, crawling, and reaching.
• Constant sitting.
• Sedentary physical force is required (exerting up to 10 pounds of force occasionally or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects).
• Ability to manage a high stress environment.

Occupational Exposure to Bloodborne Pathogens Yes or No: No

National Patient Safety Goals Improve the accuracy of patient identification Improve the effectiveness of communication among caregivers Reduce the risk of health care-associated infections Consistently demonstrate appropriate hand hygiene techniques

Core Values Teamwork

• Is an effective team player who adds complementary skills and contributes valuable ideas, opinions and feedback. Communicates in an open and candid manner and can be counted upon to fulfill any commitments made to others on the team. Compassion
• Is sensitive to the feelings of others and is consistently kind and considerate. Genuinely cares about people and is available and ready to help. Shows sincere concern, empathy, sees the best in people, accepts differences and appreciates virtues.

Integrity - Views himself or herself as a reflection of the organization by following through on commitments and accepting ownership of any mistakes he or she might make. Acts in ways that demonstrate personal honesty and serves as a positive example of why others should trust the motives of the organization.

Standards of Behavior Respect: Maintain Patients' Privacy

Professionalism: Take Ownership Safe and Healing

Environment: Keep Noise Levels Down Customer

Focus: Use the 10/5 Rule; Escort to Destination; Use Elevator Etiquette

Communication: Use AIDET (Acknowledge, Introduce, Duration, Explain, Thank)

Employee Statement of Understanding:

I have read and understand the job description for my position. I also understand that I am responsible for meeting the standards of performance outlined in this job description as well as conducting myself in a manner supportive of the mission, vision, core values and Standards of Behavior of High Point Regional Health. I certify that I possess the physical and mental abilities to regularly attend work and fulfill the essential functions of this position with or without reasonable accommodation. If I require accommodation in order to fulfill any or all of these essential functions, I will notify my manager immediately (or in the case of new employees, prior to employment).

I understand that receipt of this job description does not imply nor create a promise of employment, nor does it create an employment contract of any kind. I furthermore understand that if hired, my employment relationship with High Point Regional Health is at will and may be terminated by myself or employer at any time with or without cause. The requirements listed above are representative of the knowledge, skills, education, certifications, licensure, experience, and/or ability required to perform the job. While this job description is intended to be an accurate reflection of the current job, management reserves the right to revise the job, work schedule, and/or require that different tasks be performed when circumstances change in order to best suit the needs of the department and/or organization.