Job Details

MINIMUM QUALIFICATIONS

Education -High school diploma/GED required. Associate's Degree preferred.

Experience - One year insurance billing/medical office experience preferred.

Licenses & Certification - None
Knowledge & Skills -

1. Basic knowledge of hospital or clinic billing and follow up
2. Knowledge of medical terminology
3. Demonstrate basic knowledge of ICD-10-CM, CPT, HCPCS, and Revenue Codes
4. Basic knowledge of major insurance companies billing policies to ensure compliance
5. Basic knowledge of insurance claim forms
6. General knowledge in specific specialties within the hospital or clinic billing area
7. Ability to read, comprehend, and follow oral and written instructions
8. Ability to establish and maintain effective working relationships with patients, co-workers and the general public.

JOB SUMMARY

The purpose of this position is to ensure that all billable services such as inpatient or outpatient medical or skilled facility, emergency room, home health, ambulance, laboratory, radiology, dental, optometry, behavioral health, diabetes, and pharmacy are billed to Medicare, Medicaid, and any commercial insurer in accordance with applicable government, state, local, and tribal laws.
WORK ENVIRONMENT

Work is performed in a business office environment. Occasional overtime and travel may be required.
PHYSICAL DEMANDS

Required sitting and standing associated with a normal office environment. Manual dexterity needed for using a calculator and computer keyboard. This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, skills and working conditions may change as needs evolve.
ESSENTIAL FUNCTIONS

Satisfactory job performance will be determined by successful execution of the following:

1. Prepares, submits electronically or by hard copy and/or follows up on designated medical claims until the appropriate payment has been made.
2. Secures needed medical documentation required or requested by the insurance company.
3. Follows-up on any insurance carrier rejections and/or denials of payment in a timely manner as designated by the supervisor/manager.
4. Works courteously with other departments when needed, to obtain information or assistance in the claims process.
5. Meet productivity standards as set by the department leaders
6. Identify and resolve discrepancies and claim delay issues in a timely manner
7. Assist patients, staff and any outside entity as the need arises.
8. Make productive use of time through careful coordination of department tasks, setting priorities and reducing non-essential interruption.
9. Keep a positive attitude
10. Maintain a close working relationship with the PFS Team
11. Participate in educational activities and attend staff meetings
12. Regular attendance is required
13. Must be well organized, detail-oriented and strives to work efficiently and accurately
14. Maintain strictest confidentiality; adhere to all HIPPA guidelines and regulations
15. Adhere to the organizations (department) values and contribute to the fulfillment of its mission
16. Perform other duties as assigned

Equal Opportunity Employer
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