POSITION SUMMARY:

This position is responsible to accurately correct and verify all demographics and payer information provided by interface encounters by removing all claim holds within laboratory billing application and also all edits produced by claims at the clearinghouse in an effort to submit clean claims to Medicare, Medicaid, managed care and commercial insurance payers within timely filing guidelines as determined by hospital contracts and payer requirement.

POSITION EDUCATION/ QUALIFICATIONS­:

• High School Diploma/GED is required
• Medical coding and billing certificate preferred
• Basic computer skills are required
• Typing skills of 35 wpm
• Knowledge of basic Microsoft programs word and excel
• Good written and verbal communication skill required

JOB KNOWLEDGE/EXPERIENCE­:

• One (1) year of billing experience in medical office or hospital setting required
• Two (2) years hospital billing preferred
• Must have working knowledge billing claims using a clearinghouse
• Must have working knowledge of medical Terminology: CPT Codes. modifiers and diagnosis codes as they relate to billing
• Specific knowledge of Texas Medicare, Medicaid, Managed Care, and Commercial Health Insurances rules and regulations as they pertain to billing
• Ability to research, analyze and resolve claim edits with third party payers for proper submission of claims
• Strong time management, organizational skills and attention to detail is essential.
• Passion for excellence, commitment to customer satisfaction, patient and friendly attitude

POSITION RESPONSIBILITES:

• Responsible for the correction of all claim edits identified by clearinghouse for each payer
• Verifies completeness and accuracy of all claims prior to submission of claims
• Must research properly coding issues, diagnosis issues, and demographic issues by looking at provider billing manuals, calling insurance payers, and checking eligibility and benefits as needed.
• Responsible for working all EDI claim rejected payer reports and resubmitting those claims
• Must be able to work closely with provider clinic offices and staff to obtain missing information required by specific payer to successfully submit insurance claims to payer
• Staff Assigned to pre-billing edits will work all unbilled claim holds including but not limited to accounts missing diagnosis, missing payer information, missing demographic, failed NCD and duplicate account match failures
• Verification of all failed demographic and insurance information is to be done timely via payer websites or by calling customer service centers, patients or referring provider office as needed for corrections
• Responsible for correctly adding modifiers for received ABN’s from various locations and entering this information appropriately for billing purposes
• Pre-billing staff may be assigned to various system generated work error queues and must prioritize these to minimize any financial loss to facility and within timely filing deadlines for payers.
• Handles incoming calls and inquires routing appropriately; taking over the phone payment transactions, or assisting in resolving concerns dealing with accounts
• Work return mail, make corrections in system and re-send statement as needed
• Must meet minimum productivity standards as determined by management
• Other duties as assigned