Edit failed claims in the Claims Administrator system and correct data,
revising claim to a passed status for submission to payor for Primary,
Secondary, Tertiary, etc. Where required, create multiple claims. If error was
due to incorrect information on Paragon, then have revisions made to Paragon
and then re-bill account. Alert department responsible for error to avoid errors
in future.

Review delinquent error reports, Unbilled Aged Trial Balances to identify
reasons claims are held from billing. Satisfy those related to the Billing office.
Communicate with the front end departments, i.e.: Patient Access, Ancillary
Departments, and Medical Records for edits related to the respective area.

Monitor all related Paragon reports to identify claims requiring combination,
sequential or interim billing.

Monitor Late Charge reports daily for rebilling.

Medicare Behavioral Health Inpatients – review available benefits to
determine interim billing period.

Charity Care – validate eligibility for service period. Ensure billing data is
accurate for recurring account claims.

Review Claims Administrator Reports daily, to monitor the following:
Claims Imported
Claims Failed
Claims Not Imported

Edit Statistics (Reasons claims failed)
Prepare and perform follow-up for special and client billing for various payors.
Monitor responses from clearinghouse and payors to identify returned claims.
Adjust claims accordingly, for resubmission to the payor.
Review Aged Trial Balances for claims in billed status not yet paid. Perform
follow-up actions where required.
Manage receivables by exception. Follow-up on those not paid in accordance
with expected reimbursement. Contact payor to discuss payment variances,
submit adjustments where necessary. Prepare technical appeals where
required. Refer accounts for clinical appeal where required.
Analyze, identify and report areas of high volume error, for enhanced
automation opportunity in Paragon or Claims Administrator, or corrective
actions in front end areas.
Daily monitor and working of tickler system in Receivables Administrator to
include the following:
Work ticklers generated by system based on path assignments.
Work ticklers assigned by Claims Management, Management Team
and Self Pay teams for payor updates.
Monitor follow-up on all accounts
Utilize Horizon Patient Folder to monitor and follow-up on hardcopy
correspondence. Mitor and process all requests for Medical Record
documentation.
Monitor claims in Medicare FSS.
Maintains established departmental policies and procedures, objectives,
quality assurance program, safety, environmental, and infection control
standards. Promotes adherence to the Patient’s Bill of Rights.
Understands and adheres to departmental policies and procedures.
Adheres to the Medical Center’s Code of Conduct.

Familiar with the Medical Center’s Mission, Vision and Value statements.
Maintains established departmental policies and procedures, objectives,
quality assurance program, safety, environmental, and infection control
standards.
Customer Service: respect, flexibility, knowledge, confidence, professionalism,
pleasant attitude, patience and helpfulness. All responses should be timely,
professional, caring, and respectful in accordance with Customer Service
Performance expectations.

• OTHER JOB DUTIES
  Performs other related duties as required.
  Attends required meetings
  Assists in training of new and established employees
  Performs other related duties as required
  BASIC COMPETENCIES
  Education:
  High school graduation or equivalent required.
  Experience:
  Minimum of 1 year experience in medical billing procedures, with familiarity with third party
  insurer regulations required.
  Skills:
  Typing: 25 WPM (tested)
  Must pass alphanumeric skills test
  Intermediate level computer skills required, to include Excel and Word.
  Computerized billing knowledge essential
  Good Oral and Written communication skills
  Good interpersonal skills
  Speaks, reads and writes English to the extent required by the position.
  Ability to plan and utilize time management skills.
  Computer literate.
  Good organizational skills.