Lead Patient Billing Clerk

Title:

Patient Billing Lead Clerk Position Summary:

The Patient Accounting Lead is responsible for working with patient's, clinicians, third party payers and other payors to resolve outstanding issues and account balances while fulfilling the organization's mission of care and service by providing excellent customer service to the patient community. The Patient Accounting Lead will handle incoming calls, correspondence as well as face to face communications. They assist patients with any issues that have been escalated by the staff. They are responsible for providing orientation and training to new staff. The employee performs complex patient account follow-up activities, actively participates in performance improvement projects and assists with specials projects. This employee is expected to identify system and workflow issues and resolves problems with minimal direction. Problems encountered are of moderate to high complexity and requires a broad knowledge of the entire revenue cycle process. The Patient Billing Lead is required to oversee the payment entry process and work with the clinic and finance departments to ensure payments and adjustments are entered in a timely and accurate manner. They will work with the Finance Department to resolve outstanding AR reconciliation items. Review refund requests to ensure accuracy. The employee will work with the PFS Manager to monitor KPI and productivity metrics and report these to the

CFO and Senior Revenue Cycle Analyst Insurance Billing Specialist:

Process Medicare, Medicaid, and commercial insurance claims, MVA, 3rd Party Liability, and Workmens Comp using UB-04, and HCFA 1500's, within 5 days of bill being dropped facilitating maximum reimbursement. Analyze, update, and correct claims data according to established billing procedures determined by payer type. Maintain claims on EHR and claims clearinghouse systems for electronic submission. Analyze EHR and claims clearinghouse edit reports to identify and rectify problems. Demonstrate thorough knowledge of UB-04 and

HCFA 1500

requirements by payer, computer capabilities as related to claims production, and admitting /medical records input as they affect claims. Assist with follow up and resolution of claims with assigned responsibility that are 45 days and older. Document all follow-up activity in the Electronic Health Record. Handle phone, mail, and personal inquiries from and regarding patient accounts promptly, efficiently, and courteously. Follow through on all issues identified as requiring action as a result of inquiry. Document all phone and personal inquiries in the Meditech system. Participate in educational opportunities offered by the hospital for job and personal development. Cross train with other positions in order to ensure a smooth workflow in the department. Participate in monthly staff meetings and attends classes, workshops, seminars relating to billing/collections of accounts. Other duties as assigned.

Measurement:

Independently and accurately bills hospital and clinic claims on a timely basis. Follow hospital policy and procedures relating to billing and patient accounts. Assists with claim follow-up as needed to ensure timely and successful billing of corrected claims. Process a large number of clean hospital claims to help keep Accounts Receivable days in targeted range.

Age Requirement Required:

Must be 19 years or older

Education:

Required:

High School diploma or equivalent

Experience/Qualifications:

Experience:

Preferred:

Experience in filing hospital or doctor's office insurance claims. Experience in filing commercial insurance claims, including Medicare, Medicaid, and commercial insurance. Experience filing claims with Workmen's Compensation, Motor Vehicle, and 3rd Party Liability insurance. Knowledge of computer including navigating the internet in order to look up patient insurance information using various websites. Understanding of UB-04, and

HCFA 1500

claim forms. Experience reading and analyzing insurance remittance advices or explanation of benefits. General knowledge of health insurance billing. Must possess analytical and mathematical skills. Understanding of Microsoft Excel and Outlook. Must possess excellent keyboarding and 10-key by touch skills.

License/Certifications:

Required:

None Preferred:

Certified Patient Account Technician (CPAT) All offers of employment are subject to a background check and drug screening. EOE