Hybrid BILLING REPRESENTATIVE bei HOSPITAL FOR SPECIAL SURGERY

Description

Overall Responsibility:

Perform all data entry functions necessary for accurate and timely daily processing. This will include but is not limited to the following: perform complete chart reviews, verify patient demographics, assign modifiers, diagnosis codes, and revenue codes in accordance with coding and reimbursement guidelines resulting in claim reimbursement. 

Key tasks and responsibilities (essential functions):

• Maintains and tracks all scheduled cases for accurate billing.
• Extract information from medical records, operative notes, invoices, progress notes and discharge paperwork to ensure completeness and accuracy of charge entry.
• Capture implants, high-cost supplies, high-cost drugs, post op pain blocks and observations times prior to charge submission
• Review accuracy of invoice details, including customer billing instructions, pricing, discounts, state sales tax, etc.
• Execute the recurring billing workflow and generate and transmit claims daily for primary, secondary and tertiary balances.
• Ensure timely follow-up and resolution of internal and external inquiries of billing issues (i.e., operative notes, invoices, or implant pricing etc.).
• Reconcile revenue and billing during the period-end close process.
• Complete accurate charge entry for all assigned cases and upload to designated electronic claims clearinghouse daily.
• Resolve claim rejections daily to ensure clean claims are transmitted and received by the appropriate payer.
• Refers difficulties or problems involving billing and collection efforts immediately to the Manager.
• Monitors accuracy, timeliness and completeness of patient accounts, including; demographic, insurance, referral and pre-certification information.
• Maintains complete and accurate files of all insurance information and contracts.  Keep abreast of insurance changes and requirements.  Ensure that up to date carrier information is maintained in the computer.
• Helps maintain patient confidentiality standards for both medical and financial information.
• Maintain current knowledge of health care billing laws, rules and regulations and developments
• Participates in all compliance programs.
• Participates in loss prevention by protecting company assets and maintaining a safe environment. 
• Performs other related duties incidental to the work required in this job description.

Licensure and Certification: 

Education/Skills: High school diploma or equivalent required.  Good interpersonal skills, excellent telephone etiquette, good verbal and written communication skills. Ability to read and interpret insurance explanations of benefits and managed care contracts.

Qualifications

Experience:  At least one year experience in billing/patient account management in a healthcare setting preferred.  Proven knowledge of Medicare Compliance billing guide, Medicare/Medicaid and Managed Care contracts preferred.  Knowledge of global and bundling coding guidelines preferred.  Intermediate computer proficiency in Microsoft Office including Excel and Outlook