Performs a variety of complex clerical tasks utilizing knowledge of computerized claims transmission. Performs follow-up on accounts that may need additional charges or adjustments. Responsible for collections of various types of underpayments created after payment was received and maintains records of these variances and identifies trends.
1. Originates and/or processes records and information related to billing.
2. Obtains information from ancillary sources and incorporates into billing process; interprets insurance requirements and regulations.
3. Processes medical claims to appropriate payer within acceptable time period and following OVHD procedures.
4. Make adjustments for non-covered charges.
5. Completes QA for admitting and correct charges.
6. Performs corrections and adjustments of Medi-Care accounts on DDE as notified by Medi-Care
7. Sends request for and follows with appeals for complete Medi-Cal extensions and TARs.
8. Answers questions and concerns presented by patients, physicians, insurance companies and other hospital staff.
9. Performs research of accounts to ensure payment and/or require additional charges or adjustments.
10. Responsible for collections of various types of underpayments created after payment received. Works with payors, medical groups and other internal hospital departments in order to resolve underpayments, usually based on different interpretations of contract language or approved level of care situations.
11. Ensures compliance with Payment Card Industry (PCI) – Data Security Standards (DSS) and training, with regards to credit card transactions and cardholder information.
12. Performs continuous follow-up to ensure that demands for payment of underpayment are received.
13. Maintains records of underpayments by payors, causes for underpayments, identifying trends of underpayments and underpayment dollars collected by payor.
14. Provides management with reports on results and trends. Works with management to determine resolution to avoid future underpayments.
15. Answers incoming correspondence.
16. Performs Quality Control Procedures.
17. Follows up on patient accounts and alerts PFS Manager to problem areas.
18. Participates in the education, training programs and staff meetings of the department.
19. Performs any clerical duties required.
20. Assists in other areas of the department when needed.
Thorough understanding of HCFA 1500 and UB-92 billing required
Basic understanding of CPT and ICD-9 coding preferred
Basic knowledge of governmental and managed care programs billing requirements necessary
Three (3) years computerized medical billing or related experience preferred
Previous experience in the analysis of patient accounts to determine when and if an underpayment condition exists.
Meditech and/or computer system processing preferred
Recent experience with hospital contract language
Excellent verbal and written communication skills
PC literate, typing, data entry, 10-key PC skills preferred
Proficient in Excel
Able to perform basic mathematical calculations
Bilingual (English/Spanish) preferred
Lifts, positions, pushes up to 50 pounds
Considerable reaching, stooping, bending, kneeling, crouching
Manual dexterity and mobility
Ability to move quickly
Ability to adjust vision sufficiently to perform duties
Subject to irregular hours
Increased stress due to multiple calls and inquiries
Able to work in spite of frequent interruptions
Subject to varying and unpredictable situations