PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

• Sitting – More than 6 hours/day
• Lifting objects – 25 lbs.
• Reaching - Occasionally
• Standing – Less than 2 hours/day
• Hearing ability – Good
• Kneeling – Occasionally
• Walking – Less than 2 hours/day
• Visual ability – Good
• Bending – Occasionally
• Crouching – Occasionally
• Stooping – Occasionally

MENTAL & VISUAL DEMANDS:

Good verbal and hearing ability required for interactions with insurance companies and/or patients. Good communication skills required for daily phone contact with insurance companies. Visual ability required for daily use of computers. Ability to handle multiple projects and demands of deadlines. Ability to work with limited supervision.

WORK ENVIRONMENT:

Private work space within Patient Financial Services Department. Northern Regional Hospital is a tobacco-free campus. In the event of inclement weather, this position is classified as non-essential. Non-essential personnel are not required to be at work however; the absence will be recorded as an occurrence unless the employee has been instructed by his/her manager not to report.

NATURE OF WORK:

• Experience in all areas of billing and follow-up procedures. Experience and knowledge of CPT, HCPCS and ICD-10 coding and the Fiscal Intermediary Shared System (FISS). Experience with Medicare Secondary Payer Guidelines and steps to take to resolve MSP issues. Works traditional Medicare and Medicare Advantage accounts as well as hospice and nursing home claims due to overlaps. Reviews patient accounts monthly and follows up appropriately until the accounts are resolved. Processes daily mail for his/her accounts. Works daily reminders from the hospital customer service representatives. Reviews and processes the payer remit should there be any rejected accounts or line item denials. Works with EHR and Health Information Management on Medicare denials and appeals. Assists in researching credit balances as well as resolving those credit balances. Adheres to the hospital billing compliance plan. Assists in other areas of Patient Financial Services Department when needed.

REQUIRED QUALIFICATIONS :

• Ability to read, write and speak English clearly and fluently.
• Microsoft Office, Word, Excel, MS Windows and basic computer operations.
• Type 30 correct words per minute or enter 87 correct key strokes on the Alpha Data Entry Test.

PREFERRED QUALIFICATIONS:

• Associates Degree in Business
• Three years’ experience in insurance billing and follow-up.
• Certification from an accredited organization such as AAHAM or HFMA.
• Completion of an approved Medical Terminology courses

RESPONSIBILITIES

1. Follows up on outstanding A/R accounts.

2. Processes daily mail correspondence from payers.

3. Processes reminders from customer services or other staff.

4. Performs on-line corrections into payers’ electronic system if necessary.

5. Works remits from the payers.

6. Works with EHR and HIM on Medicare denials and appeals.

7. Works Credit Balances for Medicare and Medicare Advantage accounts.

8. Monitors rejections for trends or issues and reports findings to the PFS Manager.

9. Assists in special Medicare projects as necessary.

10. Maintains RAC spreadsheet for overpayments, underpayments and refunds as needed.

11. Maintains Post-Acute Care Transfer report as needed.

MISCELLANEOUS

1. Adheres to all hospital policies and procedures those related to compliance, general and patient safety, infection control, ethical conduct, and personnel policies & procedures.

2. Maintains acceptable attendance which includes providing proper notification and advance notice for absence/tardiness. Returns from breaks & lunch promptly.

3. Ensures strict confidentiality of patient and NRH information at all times.

4. Assumes responsibility for attending all required in-service education classes including safety update program.

5. Works cooperatively and as a team player with co-workers.

6. Utilizes excellent customer service skills.

7. Performs additional duties as assigned.