Address
Form of work**REMOTE WORK UPON TRAINING - 80% remote & 20% in-office**
This position completes the billing, and collection processes for all hospital patient service revenue that may be covered by insurance. Knowledge of government and insurance regulations, coding, reimbursement, claim requirements, adjustments, answers inquires, and updates accounts with appropriate information. The Insurance Representative must demonstrate proficiency in billing all third party payers to perform the insurance process.
Education
Minimum: High School Diploma or equivalent
Preferred: Medical Terminology
Registration/Certification/Licensure:
N/A
Experience
Minimum: One year accounting, clerical and/or physician billing experience.
Preferred: Third party hospital billing experience.
Other Requirements:
N/A
Status:
Non-Exempt
Physical Requirements:
The following frequency definitions apply to all Physical Requirements unless otherwise noted:
Occasional: (0-1/3 of day , 0 - 2.5 hrs/day, 1 - 4 reps/hr)
Frequent: (1/3 -2/3 of day , 2.5 - 5.5 hrs/day, 5 -24 reps/hr)
Constant: (> 2/3rd of day , > 5.5 hrs/day, > 24 reps/hr)
NOTE: An asterisk (*) indicates that the item is an essential function.
Occasional: (0-1/3 of day , 0 - 2.5 hrs/day, 1 - 4 reps/hr)
Frequent: (1/3 -2/3 of day , 2.5 - 5.5 hrs/day, 5 -24 reps/hr)
Constant: (> 2/3rd of day , > 5.5 hrs/day, > 24 reps/hr)
NOTE: An asterisk (*) indicates that the item is an essential function.
Non-Material Handling
Standing - Remaining on one's feet in an upright position remaining stationary - N/A
Walking - Remaining upright on one's feet, and moving about - OCCASIONAL
Sitting* - Body remains in a seated position - CONSTANT
Stooping - To bend the body downward and forward by bending the spine at the waist - OCCASIONAL
Bending - To flex the upper body forward - OCCASIONAL
Twisting - To rotate the upper body forward - OCCASIONAL
Climbing - To move the body in any direction on equipment or structures that do not include stairs or ladders - N/A
Ladders - To ascend and descend ladders - N/A
Stairs - To ascend and descend stairs - N/A
Kneeling - To move the body downwards and come to rest on both hands and both knees - N/A
Squatting - To move the body downwards by bending both knees - N/A
Crouching - To bend the body forward and downward by bending the spine and the legs - N/A
Crawling - To move the body forward or backwards on hands and knees - N/A
Reaching Horizontal - To extend the arms and hands outward, remaining under shoulder height - OCCASIONAL
Reaching Overhead - To extend the arms and hands up and out over shoulder height - OCCASIONAL
Grasping* - Using functional gripping of the hand to handle an object - CONSTANT
Finger Manipulation* - To manipulate objects with the use of fingers - CONSTANT
Seeing* - Using visual feedback to accomplish a task or activity - CONSTANT
Hearing* - Using sound feedback to accomplish a task or activity - CONSTANT
Repetitive Upper Extremity Use* - Using the arms and/or hands continuously or more than 2/3 of the total time - CONSTANT
Repetitive Lower Extremity Use - Using the legs and/or feet continuously or more than 2/3 of the total time - N/A
Material Handling
Pushing - To exert a force upon an object in order to move it in a certain direction Pushing refers to moving an object away from the person - N/A
Pulling - To exert a force upon an object in order to move it in a certain direction Pulling refers to moving an object towards the person - N/A
Lift - Floor to Waist - N/A
Lift - Waist to shoulder - N/A
Lift - Shoulder to overhead - N/A
Carrying - To transport an object or article using the arms or hands (> 10 feet)
OCCASIONAL
Up to 20#
Environmental Factors
Working alone - N/A
Working in cramped quarters - N/A
Constant interruptions - OCCASIONAL
Working with hands in water - N/A
Use of power tools - N/A
Working on ladders/scaffolding - N/A
Exposure to vibration - N/A
Exposure to dust - N/A
Exposure to noise (constant) - N/A
Exposure to electrical energy (outlets, etc) - N/A
Exposure to temperature changes (heat, cold, humidity), that require special clothing - N/A
Exposure to slippery walking surfaces - N/A
Exposure to solvents, grease, oils - N/A
Exposure to radiant energy, ie computer terminal (more than 4 hours per shift) - N/A
Working with bloodborne pathogens - N/A
Cardiovascular Energy Requirements - Physical Demand
Physical Demand
Met Level
Examples of similar activity intensity
Sedentary to Light0 - 3.5Light house cleaning, washing dishes, serving food, food shopping, sitting, standing, computer work.Medium3.6 - 6.3House work (mopping, scrubbing), health club exercising, treadmill work, stretching, yoga, walk/run-play with children, aerobic class, dancing, carrying bucket/wood, auto body repair, shoveling snow, golf (carrying clubs).Heavy to Very Heavy> 6.4Calisthenics (push up, pull up, sit up, vigorous effort), carrying groceries upstairs, shoveling coal, bailing hay, fire fighting, sawing by hand, splitting wood.As relates to this position:
Sedentary to Light - CONSTANT
Medium - N/A
Heavy to Very Heavy - N/A
I. Specific Job Responsibilities (Essential Functions):
1. Investigate and take appropriate actions on accounts to resolve to zero or self pay balance through appropriate utilization of third-party investigation tools, refunds or appropriate adjustment.
Meets Expectations Does Not Meet
2. Review all necessary claims for referrals, ABN’s, authorizations, and Medical Records.
Meets Expectations Does Not Meet
3. Reviews electronic and paper claims for accuracy according to payer edits to produce clean claims to maximize reimbursement.
Meets Expectations Does Not Meet
4. Claims are corrected and analyzed to resolve rejections based on payer.
Meets Expectations Does Not Meet
5. Handle all correspondence received from third party payers in a timely manner.
Meets Expectations Does Not Meet
II. Organizational Responsibilities:
1. Completed mandatory education, annual competencies and department specific education within established timeframes.
Meets Expectations Does Not Meet
2. Completed annual employee health requirements within established timeframes.
Meets Expectations Does Not Meet
3. Maintained license/certification, registration in good standing throughout fiscal year.
Meets Expectations Does Not Meet N/A
4. Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self. Identifies and works to reduce potentially unsafe patient care or other safety practices.
Meets Expectations Does Not Meet
5. Adheres to regulatory agency requirements, survey process and compliance.
Meets Expectations Does Not Meet
*Please use the following to determine the rating for Section I and Section II:
If employee is rated "Meets" at least 7 of 10 in Sections I and II, their rating is "Meets".
If employee is rated "Does Not Meet" for 4 or more in Sections I and II, their rating is "Does Not Meet".
Based on the above, the rating for Section I and Section II is:
Meets Expectations Does Not Meet
III. Job Behaviors:
1.“Sets the Stage” by using greetings/introductions when interacting with any customer or entering a patient room. Looks and acts like a professional. Uses consistent phone etiquette. Helps people who look lost or confused. Keeps a clean and professional environment and work space. Clarifies expectations and creates positive handoffs and positive lasting impressions.
Exceeds Expectations Meets Expectations Does Not Meet
2. Fosters a teamwork approach by respecting other members of the hospital team. Stays involved and informed of happenings within the organizations. Creates win-win situations by helping others. Works to resolve conflicts and concerns in a constructive way and asks for assistance in helpful ways.
Exceeds Expectations Meets Expectations Does Not Meet
3. Is the Owner: Takes responsibility for problems, issues or opportunities for improvement by initiating constructive review of concern rather than negatively attacking an issue. Understands systems and processes and uses appropriate channels to address concerns when out of own span of control. Demonstrates compassion and works beyond “own assignment” by seeing “big picture”.
Exceeds Expectations Meets Expectations Does Not Meet
4. Creates a Caring Environment by communicating in helpful ways. Always protects the confidentiality and dignity of patients and others. Listens with empathy and understanding and provides options and choices.
Exceeds Expectations Meets Expectations Does Not Meet
5. Provides Great Explanations through user-friendly information and explanations (uses language others can understand). Makes sure people know w...
