JOB DESCRIPTION

MEDICAL BILLING DEPARTMENT

CHARGE ENTRY REPRESENTATIVE

ECW Charge Entry– Daily

• Enter charges from progress notes in ECW encounter forms for physicians and nurse practitioners and encounter charges from encounter forms for Allergy Department. These tasks are for ParkWest, Fort Sanders and Lenoir City offices, specific doctors and departments.
• Gather surgery packets in documents and enter the charges.
• Call ParkWest Hospital Medical Records (Vicki) for paths, as needed.
• Make face sheets for encounters for each doctor from hospital.
• Adjust for specific no charge encounters.
• Make corrections to demographic information and some insurance issues for claim to process.
• Performs required daily account productivity, including accurate documentation and reporting of activity.
• Responds to phone and mail correspondence in a timely, professional manner.

ECW Denials– Daily

• Check the electronic claims that have been marked as “Ready to Submit” to ensure that all those available through the night before were gathered properly into Primary and Secondary batches and submitted to the clearinghouse, Change Healthcare.
• Check Change Healthcare to make sure batches submitted from ECW were received and are in the process of being sent to Insurance Payers for adjudication.
• Print a list of rejected claims from Change Healthcare and resolve issues preventing claims from being placed in adjudication.
• Using the rejection reason on list, correct the issue on the claim and place back into “Ready to Submit” status or Print HCFA status.
• If unable to correct claim issue with information available through ECW, assign claim back to the entry location for review and correction.

• Check the Claim Submission Error bucket and resolve any issues that kept the claim from submitting on a batch to Change Healthcare.
• Check the Patient Error bucket to ensure that no claims have been mistakenly marked as Patient status instead of Insurance status while marking claim “Ready to Submit”.
• Print Paper Claims.
• Print HCFA claim forms in Primary, Secondary, and Tertiary batches.
• Disburse Primary WC claims to PT worker with note attached containing chart # so she can pull notes from chart and attach to HCFA before mailing. Disburse any Charity claims to Billing Manager for write off/adjustment posting. Place any paper claims generated for other locations in an interoffice envelope for delivery to them. Place remaining Commercial Payer claims in envelopes.
• Pull Insurance EOBs needed for Secondary and Tertiary claims, match to appropriate claims, and place in envelopes.
• Place postage on envelopes and put into mail bin in Front Office.

• Verify the accuracy of information between the EOB and the billing system. Properly posting rejection codes per the EOB for proper denial tracking and analysis.
• Compile a general list of denied claims assigned to me and work on each claim to correct any issue that has caused the Insurance Payer to not pay the claim and then resubmit the claim for processing. This could require research on the Insurance Payer’s website or research on information from the Patient’s chart. If PT worker is unavailable, I will pull the chart information myself.
• Pull a specific list of denials that have been assigned to me with high importance and work each claim to correct any issue that has caused the Insurance Payer to not pay the claim and then resubmit the claim for processing. This could require research on the Insurance Payer’s website or research on information from the Patient’s chart. If PT worker is unavailable, I will pull the chart information myself.
• Work any recoupment requests sent by Medicare and/or Commercial Insurance payers. Research the reason for the recoupment and respond with a Corrected Claim if appropriate. If the reason for recoupment is valid, notify the payment poster of the upcoming take back.

• Work diligently, increasing knowledge of coding in both CPT and ICD10 areas. This position requires a great deal of research in making sure our claims are correct, according to the chart and encounter form. A lot of study will be done, in coding books, on websites (Super Coder, AAPC, i.e.) and other forms of documentation.
• Attend all billing office meetings and reply to all inter-billing office correspondence in a timely, professional manner, if schedule permits.
• Effectively communicates with other departments and clients to request information, as well as to review issues, concerns effecting reimbursement.
• Learns and remains knowledgeable about patients and types of services being rendered.
• Maintains up-to-date knowledge of governmental and managed care policies and procedures. Demonstrates ability to interpret and communicate regulations to ensure compliance.
• Refers to coding materials, ICD10, CPT and HCPCS, as needed.
• Demonstrates ability to audit and review accounts for reimbursement based on knowledge of billing regulations, medical terminology and coding requirements.
• Interprets patient and insurance issues and determines resolutions in a timely and accurate manner.
• Makes recommendations to management, actively participates in continuous quality improvement and enhances reimbursement.
• Adheres to organizational policy with particular attention to standards of conduct and to confidentiality as it relates to HIPAA.
• Relays to MA Supervisor any encounters needing attention (prior authorizations notes, etc).
• Work Encounters w/o Claims, Pending and Pending w/ Errors Claim Status buckets to make sure claims have been created and processed. If not, collect the appropriate medical records and process the claims. Mark “non billable” to all claims that were no show, rescheduled or cancelled appointments.
• Work closely with Billing Manager on any encounter issues that arise.

Medical Manager – Daily/Weekly

• Use system for look up of any patient account information.

Phone Duties – Daily/Weekly

• Daily/Weekly – Answer Billing Department calls on designated day.
• Take credit card payment info from patients and process in Converge.
• Answer patient questions involving accounts and resolve any issues that have caused an incorrect Patient Responsibility balance to be sent to the Patient. Direct the call as it pertains to the appropriate Billing representative.

• Daily – Assist in answering Billing Department calls when scheduled person is busy on another call or absent.
• Daily – Resolve any detailed account questions from calls transferred by other Billing Dept personnel.

Any other projects as assigned by Management.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off

Schedule:

• Monday to Friday

Experience:

• ICD-10: 1 year (Preferred)

Work Location: In person