Lead Clerk CCMC Billing

St. Elizabeth Healthcare

About The Position

At St. Elizabeth Healthcare, every role supports our mission to provide comprehensive and compassionate care to the communities we serve. For more than 160 years, St. Elizabeth Healthcare has been a trusted provider of quality care across Kentucky, Indiana, and Ohio. We’re guided by our mission to improve the health of the communities we serve and by our values of excellence, integrity, compassion, and teamwork. Our associates are the heart of everything we do.

Requirements

High school diploma or equivalent and or business courses
Experience in hospital third party billing and follow-up
PC skills
Word/Excel
detail oriented
customer service skills
communication skills
familiarity with managed care contracts and environment
knowledge of situation response guidelines
Minimum 3 years’ experience in self pay/insurance follow up activities

Responsibilities

Communicates with supervisor/Manager and payers of any issues that would prohibit claim payment.
Completes work list with the correct activity code, tickle date, phone number and account notes.
Demonstrates adequate, appropriate, and professional levels of communication with insurance company representatives, team members, supervisors, and managers.
Elevates serious barriers to claim resolution to appropriate management
Assists other associates when necessary, as determined by manager, works with staff to identify and resolve issues and develop standard practices
Maintains 91+ Agings at Management established best practice levels.
Completes special projects & tasks by the established time frame which can include organizing workload and/or associates for successful account resolution: proactively notifies supervisor of any barriers that prohibit billing and/or payment of claims.
Complex review of accounts for maximum reimbursement.
Completes other tasks and duties as assigned by manager
Assumes duties of supervisor/other lead as needed.
Assists co- worker in problem solving, with reports and work lists, meetings, etc.
Execute training of contracted staff (internal and external).
Serves as a backup in the absence of staff members.
Assign, monitor / review the task progress and ensure accurate work of a group of employees.
Provide instruction so others on the team can complete tasks quickly and effectively.
Inform management of overall performance of team members
Answer questions, offer insight and organize responsibilities within the team.
Provide technical guidance on more complex issues.
Lead the day-to-day operations of a group of employees.
Responsible for corporate accounts billing/Follow-up, maintaining contacts and staying current with changing guidelines
Responsible for combining consecutive accounts, maintaining guidelines and staying current with changing regulations
Reviews bills and related information for accuracy and reasonableness of charges
Audit claims for overlap (charges, dates, coding, condition codes, modifiers, discharge status) and resolves issues with medical records and revenue department heads.
Reviews Therapy Accounts (forms, charges, onset dates of service, value codes, Occurrence codes) working closely with department heads to resolve issues.
Audit Charity Accounts for correct adjustment and accurate qualification
Create and maintain Procedures for the department
Provide training for outside vendors
Submits bills to payers electronically if possible, otherwise paper
Proficient in Commercial/Medicare/Medicaid Government regulations and reimbursement policies
Proficient in third party contractual agreements and regulations to apply requirements for accurate billing and to make recommendations for system changes as needed
Assist Medical Records and Revenue Department on high dollar claims, changing DRG, coding, and charges on processed claims including but not limited to Consecutive Account management, Follow-up Vendor Account management and Reimbursement Account management.
Responsible for corporate accounts billing/Follow-up
Reviews bills and related information for accuracy and reasonableness of charges
Calls payers/ Patients or uses online resources to obtain status on accounts housed on work lists.
Records appropriately detailed notes in the billing system
Takes appropriate action to resolve claims, i.e., the representative will execute any and all steps to resolve unpaid claim, including but not limited to; rebill of claim.
Initiate appeals when necessary or works with Utilization Management / Risk Management for appropriate appeal process.
Calculates expected reimbursement/ Adjustments on accounts if/when necessary.
Facilities, generate spreadsheets/ invoices, track Payment/nonpayment.
Establishes relationship with payer contacts
Establish Relationship with other Departments
Performs due diligence on all collection efforts
Ensures expected reimbursement is secured
Trends weekly productivity, Billing CFB, Follow-up agings
Edit WQs (Securing required data necessary for billing.)
Assist in training staff
Completes KPI forms
Attends weekly billing staff meetings
Identifies payer & billing issues
Participates in a positive & constructive manner
Responds to internal and external customer calls or concerns.
In the absence of management will lead meetings and other operational issues.
Seeks opportunity for training & informs supervisor of all training needs.
Attends Seminars and workshops as assigned by manager, to obtain billing and/or follow up information related to specific payers
Performs other duties as assigned.
Demonstrate respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background.