Job Details
Job Location
Caldwell Medical Center - PRINCETON, KY
Description
CALDWELL MEDICAL CENTER
JOB DESCRIPTION
JOB TITLE: Medical Billing Specialist 2
DEPARTMENT: Business
REPORTS TO: Patient Financial Services Manager
POSITION SUMMARY:
The Medical Billing Specialist 2 ensures timely and accurate billing and collections of patient's accounts. The Medical Billing Specialist 2 is responsible for the timely processing of any duties or activity affecting prompt reimbursement to the hospital and clinics for services which it has rendered. This includes efficient billing of response to requests and inquiries. Employees work extensively with third party payers, state/federal/local governmental agencies, and physicians. Demonstrates vast experience in healthcare billing and follow up.
POSITION RESPONSIBILITIES
ESSENTIAL FUNCTIONS:

1. Represents the organization in a positive and professional manner.
2. Maintains and ensures patient and organizational confidentiality at all times, understand and is compliant with patient rights.
3. Complies with all organizational policies and procedures and maintains ethical business practices.
4. Communicates the mission, ethics, and goals of the facility.
5. Is courteous and respectful of fellow team members, patients, and the hospital public.
6. Performs duties in a way that ensures the team member's own safety and that of others using the services and facilities of the department and the hospital.
7. Appears well-groomed and observes established dress code policy.
8. Demonstrates knowledge of current computer systems used in the organization.
9. Has knowledge of medical terminology, various claim forms, third party contracts, payment patterns, CPT, and ICD10 coding, and reimbursement regulations, and policies of third party payers.
10. Participates in performance improvement activities, including data collection, development of indicators, and evaluation criteria.
11. Reviews hospital claims and/or clinic claimsfor accuracy and submits as applicable for insurance payment. Reviews the aging report daily and takes appropriate steps on each account to resolve outstanding balances. Assertively attempts to collect payment from applicable payer (s) in accordance with collection policy.
12. Works required number of accounts each day according to established guidelines (minimum of accounts a day TBD).
13. Completes accurate hard copy and electronic billing for all patients' accounts and submits the billing within 48 hours of "Final Bill" to the appropriate payer.
14. Bills secondary and tertiary payers within 72 hours of the posting of a payment or adjustment.
15. Processes late charges within 48 hours of receipt.
16. Works with internal auditor on third party payer audits to ensure coordination of efforts and maximum collection. Coordinates activities resulting from audit.
17. Coordinates claim and financial appeal information with governmental agency and third party payers to ensure maximum reimbursement for hospital services.
18. Responds to patient/insurance/physician inquiries in a timely and courteous manner.
19. Reviews correspondence daily, including all insurance denials, and communicates with the insurance company involved and acts accordingly, following collection policy and procedure.
20. Keeps updated on billing requirements of various insurance carriers and keeps abreast of managed care contracts.
21. Thoroughly documents all conversations and correspondence.
22. Works credit balances in a timely and appropriate manner to include preparing the Medicare quarterly credit balance report.
23. Keeps Director aware of chronic problem areas and helps identify solutions.
24. Researches problem accounts/situations as needed with the ability to trend issues.
25. Assists walk-in patients as necessary.
26. Approves settlements and discounts with payers and patients as needed adjusting and documenting accounts as appropriate.
27. Attends conferences and in-services to stay up to date in knowledge of payer requirements and regulations for billing and reimbursement and incorporate data learned into work being processed.
28. Performs other duties as assigned.

Qualifications
POSITION QUALIFICATIONS
MINIMUM EDUCATION
High School Diploma or GED.
PREFERRED EDUCATION
Associates Degree from an accredited college or university
MINIMUM EXPERIENCE
2-3 years physician billing and collection experience, claims follow-up and customer service. Hospital and/or Physician billing and collection experience may be considered. Knowledge of general office procedures and practices; as well as, collection practices and procedures.
PREFERRED EXPERIENCE
3-5 Years experience in hospital/clinic billing, experience in CPSI Thrive, DDE, e-Clinical Works and TruBridge clearing house software a bonus.