Professional Billing Team Lead | Professional Billing

Working Team Lead responsible for Billing Staff oversight to include: Understanding of system functions including but not limited to; Hospital Information System (HIS), document storage systems, claims editing system, clearinghouse, Release of Information (ROI) module.

Ensures proper billing, continually reviews payers edits for compliance, recommends edit creation and enhancements, assists with edit testing, educating team once placed into production. Understanding of payer requirements for claims payment; including supporting documentation in order to minimize denials. Stays abreast of payer billing and reimbursement changes, reviewing with management to evaluate the impacts and necessary steps to maintain compliance and maximize reimbursement.

Knowledge of payer contracts with respect to billing requirements, proper bill type, fee schedules, expected reimbursement, addresses payer issues, escalating to management for support as needed. Knowledge of Medicare, Medicaid, Commercial, Bureau of Workers Compensation (BWC) Self-Insured, and BWC Managed Care plan billing requirements. Knowledge of payment posting related to account activity, claims reprocessing and account adjustments.

Claims Processing and Accounts Receivable (AR) Management. Processes claims for primary, secondary and tertiary, using billing editing software to research and resolve payer based edits, reaching out to various departments for clarification as appropriate. Updates patient and payer demographics, processing Real Time Eligibility (RTE) to verify coverage prior to adding to account, ensures proper eligibility dates on coverage records.

Add Account Activities in HIS, detailing account actions. Processes claim from various work queues (WQ) related to claim denials, account receivable follow-up, reaching out to the payer for clarification as appropriate to expedite payment. Maintains AR at or above departmental standard and established goals.

Responds timely to account inquiries received from patients, co-workers, and insurance companies. Team Training and Resource: Responsible for billing team training including but not limited to; Hospital Information System (HIS), document storage systems, claims editing system, clearinghouse, Release of Information (ROI) module.

Assist team members with access and education related to system functions, payer websites, claims processing schedules, expectations of claims submission, and accounts receivable (AR) and work queue (WQ) management, Bureau of Workers Compensation (BWC) self-insured and managed care plans. Critical Thinking: Actively looks for and creates opportunities to improve department, staff and personal development.

Develops and demonstrates knowledge of current developments in field to maintain competency. Utilizes hospital and departmental policies and procedures. Interpersonal: Acts as a resource for new employees and precepts as needed.

All interactions are conducted in a professional manner. Demonstrates a positive attitude, Provides excellent customer service, facilitates quality care delivery and fosters an atmosphere of understanding cultural diversity, Communicates dissatisfaction with issues to Director; actively contributes to the solution of problems and refrains from promoting dissatisfaction among co-workers. Must be a team player; cooperate with co-workers to resolve conflict through one on one negotiation or with the assistance of the Director or their designee.

Maintains confidentiality at all times to protect patient's privacy and maintains Health Insurance Portability and Accountability Act (HIPAA) privacy and security regulations. Documentation: Documents thoroughly and accurately to ensure understanding of actions, Documentation is completed on a daily basis, Understands the importance of accurate completion of documentation and Hospital accreditation requirements and how it impacts hospital payment and certification programs. Education: HIPAA privacy regulations and related procedures, CMS updates on patient rights, Medicare Secondary Payor Questionnaire (MSPQ) billing compliance.

Requirements

Completion of high school education. Three (3) years experience in hospital billing/registration; Associate's or Bachelor's degree preferred.

Established knowledge and experience with hospital billing, preferably with Medicare and/or other federal/state regulatory payers. Ability to comprehend and perform verbal and written instructions and procedures with the ability to respond effectively to time sensitive requests. Must have knowledge of office practices and procedures, preferably medical terminology.

Knowledge of hospital third party billing requirements, Current Procedural Terminology (CPT), International Classification of Disease (ICD)-9, ICD-10 and modifiers, medical terminology, Medicare and Medicaid fee schedules and claim payment methodologies; general knowledge of third party payer contract language. Computer skills in Microsoft Office: Excel, Word, and Outlook, strong knowledge of web applications; ability to communicate effectively. Proficient in Microsoft Word and Excel.

Shift

1st

Hours

80 per pay (Every two weeks)

Benefits

• Medical Insurance

• Dental Insurance

• Vision Insurance

• Life Insurance

• Flexible Spending Account

Time Off

• Vacation

• Sick Leave

• 11 Paid Holidays

• Personal Day

Retirement

• Ohio Public Employee Retirement System

• Deferred Compensation

Other

• Tuition Reimbursement

• Kidzlink Daycare Center

• Employee Recognition

• Free Parking

• Wellness Center

• Competitive Salaries

• Community/Family Atmosphere