Job Description

Job Description

PRIMARY PURPOSE

Prepares, verifies, corrects, and submits paper and electronic insurance claims to ensure accuracy, expedite payment processing and ensure the financial viability of Parkland Health & Hospital System is maintained. MINIMUM

SPECIFICATIONS

Education:

- Must have a High School diploma or GED.

Experience:

- Must have three (3) years experience in a hospital or business office to include two (2) years of experience in medical billing.

Equivalent Education and/or Experience:

- May have an equivalent combination of education and/or experience in lieu of specific education and/or experience as stated above.

Certification/Registration/Licensure:

- None

Skills or Special Abilities:

- Must possess strong analytical skills to ensure accurate and timely completion of assigned tasks.

- Must have basic knowledge of HCFA 1500 and UB-92 billing and various payor billing requirements.

- Must have basic understanding of CPT and ICD-9 coding.

- Must be able to demonstrate a working knowledge of personal computers and other standard office equipment.

- Must have a working knowledge of medical software.

- Must be detail oriented, possess basic mathematical skills, and have sharp analytical skills to resolve financial issues as they relate to multiple groups including third party payors, physicians, patients and Parkland.

- Must demonstrate a positive demeanor, good verbal and written communication skills, and be professional in both appearance and approach.

- Must be able to handle potentially stressful situations and multiple tasks simultaneously including correcting billing errors and ensuring that daily paper claims are processed.

- Must be able to solve problems within the guidelines of established policies and procedures.

- Must be able to process at least 150 claims per day to all third party payors.

- Basic medical terminology knowledge preferred.

- Bilingual skills preferred

Responsibilities

1. Reviews claims for accuracy, performs required edits, and submits claims and rebills to payors daily in manual and/or electronic format to ensure accurate and timely filing of claims and prompt payment.

2. Reports all recurring rejected claims to management for evaluation of impact on the timely filing of claims.

3. Reviews the Missing Element report and notifies Medical Records of impending filing deadlines to ensure all efforts are made to receive proper diagnosis codes in a timely manner.
4. Requests additional information from patients, insurance carriers, clerical staff, and other Parkland departments to make corrections to claims.
5. Documents all actions taken on accounts in the system account notes to ensure all prior actions are noted and understandable by others.
6. Informs the Supervisor of any problems or changes in payor requirements. Exercises independent judgment to analyze and report repetitive edit failures so that corrective actions can be taken.
7. Tracks productivity and provides cumulative reports on a daily, weekly or monthly basis, as required by supervisor and/or manager.
8. Maintains a positive working relationship with contacts at all agencies, patients, insurance companies, government entities, clinical personnel, other Parkland staff and management, to promote teamwork, cooperation, and a positive public image for Parkland. Serves as a positive role model for staff and patients and demonstrates strong interpersonal skills. Accepts constructive criticism and integrates suggestions in effective ways.

Job Accountabilities

1. Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.

2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.

3. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.

Job Tags

Work at office,

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