Demonstrates knowledge and skills necessary to provide services based on the physical, psychosocial, educational, safety, and other related criteria appropriate population in his/her assigned area
Maintains required core competencies.
Complies with set Policies and Procedures (i.e. name tag, dress code, parking, smoking, etc.)
Submits all clean claims to the appropriate insurance payer the same day the claim is loaded into the Editor with the exception of weekends and Holidays
Reviews payer EOB’s but not limited to payment accuracy, patient liability, updating the financial class, notify commercial biller to submit secondary or tertiary insurance, and appeal grievance.
Files appeals on denied claims and/or forwards to the Nurse Auditor for review/appeal
Enter denials on the Denial Log
Enter the USPS tracking number in the Patient Accounts system
Enter the USPS delivered date in the Patient Accounts system
Contact payer to ensure an appeal was received
Maintain better than an 80% clean claim average.
Attach but not limited to the medical records, implant invoice, and itemized bill to the claim before billing if applicable
Process incoming mail correspondence from the payers within 3 business days
Work assigned billing reports within 2 business days
Work the rejection report daily to resolve problem accounts
Follow up with the payer via phone and/or the website for the status of outstanding claims
Respond to patient inquiries within 2 business days
Respond to interdepartmental inquiries within 2 business days
Respond to payer requests within 2 business days
Respond to emails within 2 business days
Submit newborn notifications if applicable
Review/resolve the accounts on the Unbilled Report daily (accounts that are on hold and haven’t been processed by the editor).
Enter detailed notes explaining account activity in the Patient Accounts system
Process payments over the phone if applicable
Print UB and 1500 hardcopy claims when required by the payer
Submit primary, secondary and tertiary claims before the timely filing deadline
Bill Medicare and Medicare HMO claims to the appropriate payer within the timely filing deadline. Maintain a clean claim submission rate of 80%. Work assigned billing reports timely. Ensure Medicare HMO claims are submitted to the correct billing address. Attach the necessary documentation to the claim for reimbursement
High School diploma or equivalent. Current American Heart – HeartSaver or Basic Life Support (BLS) card. Prefer two (2) years of hospital or physician practice billing and/or collections experience. Able to work high volume accounts for resolution. Working knowledge of computers and calculators desired. Possess the ability to work with internal and external customers.