About The Role

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Full Time

Job Summary: Performs any clerical billing responsibility assigned to ensure that patient accounts are processed in a manner that results in prompt and maximized payment. Acts as a liaison between Patient Account Services, physician offices, patients and third party carriers to identify and resolve any related issues. Works closely with the Team Leader to ensure department goals are met.

Minimum Education: High School Diploma or GED.

Licensure, Registration and/or Certification: None.

Work Experience: 3 - 4 years related experience.

Knowledge, Skills and Abilities: Ability to utilize a ten key by touch and typing/keyboarding skills. Basic computer knowledge and skills. Good communication skills - written and verbal. Good grammar skills. Basic understanding of a professional business environment. Basic knowledge of CPT and ICD9 codes.

Essential Functions and Responsibilities: According to established protocols, monitor, research and update patient accounts to reconcile and maximize reimbursement. Answer patient, insurance calls and correspondence resolving questions in a time frame that meets or exceeds MGMA standards. Acts as liaison between patient accounts and physician offices, insurance carriers and other third party payers to assist with questions and resolve unpaid accounts. Using SFHS guidelines adjust accounts based upon the patient/account status (deceased patient, small balance, charity, etc.) Review past due self pay balances for assignment to outside collection sources. Monitors daily electronic claims transmission, researches and resolves electronic claim rejections, understands and performs charge corrections, understand the rejection code subsystem and ensures accurate postings of rejections codes, reviews insurance reimbursement to verify compliance with fee schedules, appeal underpayments using correct venue per third party carriers, and review insurance payments for correct reimbursement. Performs all billing related duties as needed.

Decision Making: Independent judgment in making minor decisions where alternatives are limited and standard policies/protocols have been established.

Working Relationships: Works directly with patients and/or customers. Works with internal customers via telephone or face to face interaction. Works with external customers via telephone or face to face interaction. Works with other healthcare professionals and staff.

Special Job Dimensions: None.

Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.

Orthopedics - TBJ Admin - Warren Clinic