Key skills
Communication
About this role
Role Overview
- Provide exemplary customer service.
- Works daily electronic billing system (Cerner & nThrive) and submits insurance claims to third-party payers; reviews daily claim edits from the hospital billing system and makes necessary corrections to allow electronic submission.
- Assessing and analyzing claim edits daily within the billing system leading to a resolution within 24-48 hours.
- Maintains a thorough understanding of federal and state regulations as well as requirements specific to Medicare, Medicaid, and fiscal intermediaries in order to promote compliant claims submission practices for governmental claims.
- Communicates any edits that may need joint resolution with external departments.
- Prepares and submits manual insurance claims to third-party payers who do not accept electronic claims or who require special handling.
- Resubmission of claims that may need corrections.
- Verify that claims have been received by the appropriate payer.
- Investigate and resolve any issues in regards to claim transmission.
- Mail/Fax/Email paper claims to the appropriate payer the day they are generated.
- Performs effective, timely and efficient follow-up on all outstanding debit and credit balances within the expected time period.
- Review and analyze outstanding debit and credit balances to determine appropriate follow-up.
- Contributes innovatively to the success of our department and is compliant in all patient and billing aspects.
- Maintains a base-line understanding of federal and state regulations, as well as specific payer requirements and explanation of benefits to ensure compliance.
- Effectively handles communications, including email, telephone and instant message, from payers and departments within and outside of the department.
- Understands and maintains compliance with HIPAA guidelines when handling patient information.
- Reviews, processes, and resolves all incoming patient and insurance correspondence within one business day.
- Reviews and prepares responses to correspondence from patients and insurance carriers within a reasonable time frame.
- Responds to formal communication, both external and internal, within a reasonable time frame.
- Documents all activity taken within an encounter in the billing system.
- Clear and concise messaging.
- Responsible for making and documenting timely phone calls to insurance in regards to billing matters within the billing system.
- Provides updates to existing policies and procedures as needed and proposes new.
- Communicates with staff routinely and effectively using all forms of communication.
- Builds relationships and fosters positive communication with applicable departments outside of PFS.
- Documents all activity
- each time an account is touched
- in the notes section of the AR Host I.S. System, at the account level, appropriately, timely, compliantly and thoroughly.
- Stays current on healthcare regulations.
- Attends training sessions, internal and external.
- Performs other related duties as assigned.
Requirements
- High school diploma/GED or higher education