BILLING SPECIALIST II

Description

JOB SUMMARY:

This position is responsible for the billing and collection functions (a/k/a claims filing) of the institutional and professional services rendered by the Hospital Authority of Miller County (HAMC) to its patients.  The Biller will work under the direction of Patient Financial Services Leadership to carry out duties pertaining to the claim’s life-cycle.

GENERAL REQUIREMENTS:

• Performs all job responsibilities in alignment with the mission and vision of the organization.
• Performs other duties as required and completes all job functions as per departmental policies and procedures.
• Maintains current knowledge in present areas of responsibility (i.e., self-education, attends ongoing educational programs).
• Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time.
• Wears protective clothing and equipment as appropriate.

GENERAL SKILLS:

• Ability to communicate in English, both verbally and in writing.
• Additional languages preferred.
• Strong written and verbal skills.
• Basic Computer Skills

WORKING CONDITIONS:

• General environment: Works in a well-lighted, air-conditioned area, with moderate noise levels.
• May be exposed to high noise levels and bright lights.
• May be exposed to limited hazardous substances or body fluids, or infectious organisms.
• May be required to change from one task to another or different nature without loss of efficiency or composure.
• Periods of high stress and fluctuating workloads may occur.
• May be scheduled as needed including overtime.

PHYSICAL REQUIRMENTS & DEMANDS:

• Have near normal hearing: Hear alarms/telephone/normal speaking voice.
• Have near normal vision: Clarity of vision (both near and far), ability to distinguish colors.
• Have good manual dexterity.
• Have good eye-hand foot coordination.
• Ability to perform repetitive tasks/motion.
• Continuously within shift (67-100%): Standing, Walking.
• Frequently within shift (34-66%): Bending/Stooping, Pushing/Pulling, Lift/carry up to 20lbs, Lift/carry > 20 lbs. with assistance.
• Occasionally within shift (1-33%): Sitting, Climbing, Twist at waist, Lift/Carry > 50 lbs. with assistance, Reaching above shoulder.

MISSION STATEMENT:

QUALITY HEALTHCARE: In our continuing effort to enhance the quality of life for the communities we serve, the Hospital Authority of Miller County is committed to the delivery of superior, safe, cost-effective healthcare through the provisions of education prevention, diagnosis and treatment.

JOB SPECIFIC COMPETENCIES:

• Prepare, review and transmit 837 inpatient and outpatient claims using the billing software for electronic and paper claim submission
• Follow-up on unpaid claims aged over 30 days, notating status in the billing software
• Coordinate with the Patient Access Representatives to verify and understand the patient’s benefits and eligibility
• Process account payments, adjustments, reconciliations, and refunds within the timeframe set by the insurance company
• Participate in required departmental training which may include training provided by Relias, HomeTown Health, Georgia Hospital Association, Medicaid, Medicare and various other trade organizations
• Demonstrate problem-solving skills in the areas of denials, appeals, and collections
• Demonstrate knowledge of Medicaid, Medicare, HMOs, PPOs, CMOs and other payer’s requirements
• Demonstrate proper understanding of Electronic Health Record and Billing software systems, Microsoft Office Suites and other office equipment
• Demonstrate ability to write appeals for denied claims at Level 1
• Must possess critical thinking and problem-solving skills
• Demonstrate the ability to thrive in a fast-paced work environment while giving excellent attention to detail
• Complete special Revenue Cycle Management projects as required or assigned
• Other responsibilities as assigned

PROFESSIONAL REQUIREMENTS:

• Follows Code of Conduct policy.
• Adheres to dress code; appearance is neat and clean.
• Completes annual educational requirements.
• Maintains regulatory requirements.
• Maintains patient confidentiality at all times.
• Reports to work on time and as scheduled; completes work within designated time.
• Wears identification when on duty; uses computerized time clock system correctly.
• Completes in-services and returns in a timely fashion.
• Attends annual review and/or skills fair and department in-services, as scheduled.
• Attempts to end conversations and other interactions in a positive manner; leaves others with a good impression of the Hospital Authority of Miller County and its employees.
• Complies with all organizational policies regarding ethical business practices.
• Communicates the mission statement of the organization.

GUEST RELATIONS STANDARDS:

(All guest relation violations are subject to disciplinary action up to and including termination):

• Always treat others in a friendly, helpful manner.
• Refers co-workers to proper sources when unable to provide an answer.
• Interacts with others in a professional and friendly manner.
• Takes interest in others and always gives full cooperation to fellow workers.
• Always maintains an open line of communication with other departments.
• Thoroughly familiar with the hospital and the services it offers.

OTHER:

• Responsibility to Report: It is the responsibility of every employee of HAMC to comply with federal, state and local laws and regulations, as well as, HAMC Policies and Procedures. Every employee is help accountable to participate in, comply with and report concerns to his or her supervisor or the Compliance Officer if illegal or unethical behavior is suspected.
• As an employee of HAMC, you have been granted user access to applicable ePHI systems based on your position. This user or role-based access is intended to give you the minimum necessary access to perform your job function(s) only and should be used only as applicable.

OTHER DUITIES:

• Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Qualifications

EDUCATION, CREDENTIALS & EXPERIENCE REQUIREMENTS:

• 5 years of experience in various healthcare settings of revenue cycle management
• Experience and knowledge in commercial and government payer policies, regulations, and requirements
• Proficient in understanding and reconciling EOB’s
• Experience in Cerner preferred, but not required
• High school diploma or equivalent required