Biller

Winner Regional Healthcare Center•Winner, SD

13d

About The Position

Position Summary: CODER: Reviews medical documentation from physicians and other healthcare providers. Assigns diagnostic and procedure codes for inpatient, outpatient, symptoms, diseases, injuries, surgeries and treatments according to official classification systems and standards. Provides accurate and timely ICD-10 CM and CPT procedure coding, and may utilize HCPCS, in accordance with official coding standards, regulatory coding compliance guidelines and company procedures. Review and update medical record documentation to accurately reflect healthcare coding and substantiate appropriate service reimbursement. Working with other departments and organizations to assure availability and quality of information used in statistical reporting for local facility management and helping identify overall healthcare trends, issues and concerns. Follow up of coding denials and regular maintenance of coding work queues. INSURANCE APPLICATION SUPPORT: Updates Winner Regional patient billing system with current demographic and insurance information for hospital and clinic charges. The insurance application support is responsible for investigating and confirming valid insurance data if unable to determine from the source document. The insurance application support may also be responsible for preparing charge tickets for data entry. The insurance application support may also perform follow-up with payers where claims have been filed. Performs re filing of claims when necessary. MEDICAL BILLER: Manages patient's accounts following guidelines for disposition of unpaid services, i.e. intervening with third party payers. Answers incoming calls from patients and third-party payers requesting information on their account Submits and follows up on insurance claims Attributes to include: Knowledge of CAH & RHC coding guidelines, patient account policies, insurance participation/payer guidelines, and individual clinic practices/standards of operation. Knowledge of insurance processing functions. Skills in verbal and written communication. Ability to work effectively with patients, physicians, managers, directors, staff and the public. Ability to work with the compliance department to achieve coding goals. Knowledge of insurance procedures and practices Knowledge of computerized system. Skill in operating office equipment Ability to deal courteously with patients, outside organizations, co-workers on the telephone and in person. Ability to react calmly and effectively in conflict situations. Ability to speak clearly and concisely. Ability to establish priorities, coordinate work activities and meet deadlines. Bimonthly provider chart audits and provider feedback. Knowledge of medical billing practices, insurance procedures and practices. Tact and courtesy in dealing with all customers. Able to work with limited supervision. Must have good knowledge of claim processing. Must be able to pay attention to details. Must be able to understand all insurance updates. Must be able to concentrate on work tasks amidst distractions. Must exert self-control in difficult situations. Consistently projects a positive image of the facility.

Requirements

High School diploma or GED is required.
One year experience in data processing.
Knowledge of medical terminology and anatomy
Computer skills are essential.
Certified Professional Coder CPC) Certification
Ability to read, write, speak and understand the English language and follow oral or written instruction.
Excellent oral and written communication skills, work with customers and co-workers in a professional manner.
Must be able to concentrate on work tasks amidst distractions.
Must exert self-control in difficult situations.

Nice To Haves

Prefer one year of patient service experience in a health care organization, preferably in a medical office setting
Experience in registration and insurance verification is preferred.
Experience in medical billing is preferred.
Experience in Epic with both HB and PB a plus.

Responsibilities

Coding Duties (CPC) Code physician professional services accurately and in a timely manner.
Maintain and routinely work queues and follow up on coding denials.
Verifies accuracy of patient information in the database as needed.
Demonstrates ability to review patient related correspondence, literature and reports.
Promptly investigates problems and demonstrates ability to resolve routine problems and appropriately refers complex problems as appropriate to the Site Supervisor.
Participates with other staff to seek account resolution Updates patient account database.
Provides CPT and ICD-10 coding on clinic charges.
Attend required meetings and participate in committees as requested.
Works with physician/provider to resolve coding issues.
Ensures that provider education and updates are provided at opportune times Handles coding/billing calls and questions from patients and other staff to seek account resolution.
Submit State lab bills, lab charges (Chlamydia/GC).
Sanford Pathology Bill Medicaid referral cards Answers billing questions
Customer Service Introduces self immediately when working with customers.
Help create a positive experience when interacting with patients, visitors, and coworkers and demonstrates effective listening skills.
Meets internal and external customer requests by either completing the task or seeking the appropriate assistance of others.
Demonstrates understanding of Performance Improvement principles and activities by participating and/or supporting department/organizational performance improvement initiatives.
Demonstrates compliance with the Code of Conduct through actions, behaviors, and words.
Greets every employee and customer with a warm and friendly smile.
Computerized Insurance Records Accurately updates computer system to reflect correct patient demographics and insurance regarding hospital and clinic charges
Completes demographic updates in a timely manner and prioritizes duties based on date of service and revenue amounts.
Reviews updated accounts receivable to ensure that all charges have been filed to correct insurance carrier.
Make changes/corrections as needed.
Corrects patient or insurance carrier as needed to receive current and correct demographic and insurance information.
Communicates need for assistance and pertinent insurance updates to customer service staff.
Meet or exceed performance standards set by the department.
Ensures correct reparation of charge tickets has been completed for data entry, including hash totals when requested
Professional Development Identifies own learning needs and goals and develops a plan to meet them Accepts coding assignments as able to enhance learning Participate in learning opportunities
Additional Duties Identifies accounts that have had no insurance response and phone payer as a follow up.
Processes refunds to patients and insurance companies
Enters accurate notes on patient accounts.
Attends required meetings and participates on committees as requested.
Respects at all times the confidentiality of patient and uses complete discretion when discussing patient
Other tasks as assigned.