POSITION SUMMARY: This position is responsible for the analyzing, posting and correction of hospital charges submitted to the change entry unit, in order to send complaint billing to the insurance carriers and patients.
POSITION RESPONSIBILITIES: Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices Interviews patient or responsible party to obtain demographic information required to register the patient accurately.
Obtains and reviews doctors orders for appropriate signature, date, diagnosis and admission status prior to registration. Reviews and confirms patient's financial information by obtaining the insurance carrier information, benefit information, policy number, group name and group number. Ability to identify the appropriate coordination of benefits for insurance carrier.
Utilizes on-line verification systems, i.e. TMHP, FISS, and Availity, etc., for eligibility. Explains rates, estimates charges for services and hospital policy regarding up-front collections as needed Input CPT and/or HCPCS procedure-based charges from patient 3M coding abstracts and modifiers into the patient accounting system.
Accurately completes the Medicare Secondary Payer (MSP) form as appropriate. Initiates Pathway Compliance Advisor to determine if an ABN will need to be provided to patient for services identified as not medically necessary. Provides patient the Important Message from Medicare for all Medicare inpatient admissions.
Ensures patients are provided Conditions of Admission form and signature is obtained Ability to identify and input charges according to primary and secondary procedural charges, when multiple procedures are performed Review account for charge completeness and/or corrections and remove bill hold flag indicator on completed accounts. Review and correct any date or quantity discrepancies on patient accounts. Accurately removes and adds incorrect charges or adds missing charges as needed.
Daily obtains departmental charges and schedules to reconcile patient charge sheets against final daily schedule and input charges. Investigate, add or remove charges/codes for the coding department, Auditor and/or Billing Department as necessary. Identify charge codes and mark-up charge amounts for all departments.
Identify and input supply charges from green sheets Review L&D green sheets, place accounts on hold, review anesthesia time to ensure accuracy and charge anesthesia and delivery care as needed. Correct account date ranges for Lab and Pre-Op patients as necessary. Notify billers of corrections re-bills that are received from coders via email or abstracts.
Prep and scan green sheets and miscellaneous charge sheets into AX imaging system. Identify and place accounts on hold to prevent late charges. Ability to run Crystal reports and Paragon reports Reconciles Paragon charges to documentation in PICIS for ER billing compliance.
Demonstrates knowledge in accessing EMR patient record for additional billing information needed.
Daily pulls, works, and corrects the interface Posting Error Report. Hold, maintain, and monitor Lab send-out accounts and Rehab accounts requiring CMG information.
Create charge codes and maintain Charge Description Master, ensuring that all systems are in sync. Update Reference Master Table, as needed. Ensures patient confidentiality requirements are met in accordance with HIPAA policies and procedures. Other duties as assigned.
POSITION EDUCATION/QUALIFICATIONS: High school diploma/GED is required.
One to two (1-2) years of hospital billing experience may substitute for educational requirements. Previous healthcare experience (1-2 yrs.) is required, hospital experience preferred. Comprehensive knowledge of healthcare reimbursement, medical terminology, CPT, ICD, and HCPCS codes.
Good written and verbal communication skills are required. Ability to read, write and speak English Ability to communicate clearly and concisely with all levels of management. JOB KNOWLEDGE/EXPERIENCE:
One Two (1-2) years Hospital billing experience preferred Medical Terminology, ICD-9 Codes, CPT Codes, HCPCS code, Modifier knowledge is preferred Understanding of hospital chargeable supplies, preferred Microsoft office suite computer skills are required, Excel knowledge preferred. Requires good communication and organizational skills. Requires reasoning ability, analytical skills and good independent judgment. Requires working with frequent interruptions.
Doctor's Hospital At Renaissance