Essential Job Duties and Responsibilities:

The following description of the job responsibilities and performance expectations are intended to reflect the primary responsibilities of the job, but are not intended to describe all duties other responsibilities as may be assigned from time to time.

• Collaborates with Insurance Coordinator on Insurance Authorizations, claim numbers and adjusters.
• Works with Pre-Admissions clerk of any cancellations and no show fees.
• Communicates with any and every Adjuster, Nurse Case Manager and Benefits Organizer for negotiations on services rendered.
• Collaborates with the Patient Accounting Coordinator, Business Office Manager and the CFO.
• Maintains diagnostic master file and CPT master file in accordance with SIS guidelines.
• Maintains (on an interim basis) the procedure code master file; evaluates and develops new entries.
• Interprets and enforces third party payer rules and regulations; including Medicare requirements.
• Works with physician offices to resolve coding issues.
• Responds to patient and family member questions and refers questions to healthcare providers when appropriate.
• Counsels patients about Facility charges such as financial obligations, explaining fees, and reimbursement process.
• Collects information for planning a payment schedule for the patient.
• Maintains knowledge of and complies with established policies and procedures.
• Audits accounts to assure compliance with applicable laws and regulations relative to fraud and abuse issues.
• Monitors Medicare reimbursements and maintains files.
• Knowledge of coding policies and procedures; established in accordance with HCFA and third party payers.
• Bills and follow-ups with third party payers and patients for services received in accordance to Facility Policy and Procedures.
• Maintains knowledge of Medicare and third party contracts as it relates to hospitals.
• Ensures all billing and coding requirements are completed which relate to month-end closing.
• Maintains a high level of proficiency in computer applications.
• Maintains the strictest confidentiality.
• Performs related work as required.

Requirements Qualification Requirements:

• High School Diploma or equivalent.
• Excellent communication skills using proper English grammar.
• Minimum 2 years of billing experience.
• Familiar with patient accounting software, especially AdvantX.
• Ability to read and understand insurance explanations of benefits and managed care contracts
• Knowledge of Internet Explorer, Microsoft Excel, Microsoft Word, and Outlook.