POSITION SUMMARY
This position has responsibility for a full range of technical services of billing functions that includes the oversight of properly executed claims on a timely basis to third party payers and responsible parties, and rebilling or correcting previously submitted billing of accounts. The incumbent determines the most accurate and descriptive codes in accordance with CPT/HCPCS coding guidelines set forth by the Health Care Financing Administration (HCFA) and other third party payers. The incumbent has regular and recurring contact with employees, patients, families, Contract/ Third Party Payers, Clinical Services Professionals and Administrative staff and constant contact with the Compliance Office, Utilization Review, and Insurance Institutions.
ESSENTIAL FUNCTIONS:
Technician I:
- Receives and examines alternate resources of claims to assure claims are complete with appropriate supporting documents which typically include utilization review certifications. Responsible for transmission of all third party claims in a timely matter as specified by policy and procedures.
- Verifies accuracy of patient account number, claim amount is authorized, and appropriate regulations, decisions, directives and other controlling guides allow items of services billed. Identifies errors, omissions, duplications in documents and contact the appropriate individuals to resolve problem.
- Searches and abstracts all CPT, ICD9, and HCPCS coding and all other pertinent data from the medical records in order to identify and document appropriate patient care and other information necessary for billing.
- Identifies inconsistencies or discrepancies in medical documentation by notifying the appropriate providers and/or all other departments within the facility for complete charge capture and abstraction. All providers and identified risk departments will follow-up to assure completion in compliance with hospital’s policy and compliance program. Keeps this system updated at all times to ensure accurate reports.
- Consults with the attending physician, laboratory, radiology and all other necessary departments for compliance with all the regulations and guidelines pertinent to False Claims Act and Compliance program in preparation for itemized billing.
- Reviews system generated reports daily to identify claims that are ready for billing. Prepares and submits claims to third party payers, intermediaries or responsible parties within 48 hours after all information for billing becomes available.
- Responsible for the error correction for all rejected/suspended claims previously submitted to third party payers and intermediaries and patients according to hospital policy and procedures.
- Responsible for keeping up to date with assigned payer billing rules and guidelines.
- Performs other duties and responsibilities as assigned.
Technician II/III:
- Responsible for super-user duties; researching and troubleshooting issues, assist with new system and process implementation, assist with system upgrades and testing, and complete system training certifications.
- Perform case work duties such as in-depth research and maintaining of files related to workman’s compensation and motor vehicle accidents from open to closed cases. Communicates closely with employee, employer, payer, attorneys, and all others involved in each case. Submits and releases liens with county courthouses. Performs the negotiation process with all third party payers, intermediaries, and patients.
- Performs all duties of Technician Level.
- Performs other duties and responsibilities as assigned.
- Ensure proper PPE is always worn while on duty including but not limited to, face mask, gloves, gown, isolation gown, NIOSH-approved N95 filtering facepiece respirator or higher, if available), and eye or face shield.
- Complete all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly. (see CDC website for most current updates)
- Complete task training for all routine cleaning and decontamination processes for all surfaces contaminated by a communicable disease to ensure a high level of patient, visitor, employee, and external customer satisfaction
MENTAL AND PHYSICAL EFFORT
The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Physical:
The work is primarily sedentary, must have ability to sit for a prolonged period of time, and occasionally stand, walk, drive, bend, climb, kneel, crouch, twist, maintain balance, and reach. Must have ability to lift, push and pull over 100lbs occasionally. Sensory Requirements for position include prolonged telephone use, frequent far, near and color vision, depth perception, seeing fine details, hearing normal speech, and hearing overhead pages. Must have ability of both hand manipulation in prolonged use of keyboards, and frequent simple/firm grasping and fine manipulation.
Mental:
Exercises initiative and judgment in deviating from existing department or corporation practices to resolve billing issues/concerns. Work is reviewed for conformance to policies, procedures, and practices relating to billing practices. Must have ability of prolonged concentration and to work alone, frequent ability to cope with high levels of stress, make decisions under high pressure, handle multiple priorities in stressful situation, demonstrate high degree of patience, adapt to shift work, work in areas that are close and crowded, and occasionally cope with anger/fear/hostility of others in a calm way, manage altercations, and handle a high degree of flexibility including frequently accepting a flexible schedule to meet unit needs.
Environmental:
May occasionally be exposed to infectious disease, chemical agents, dust, fumes, gases, extremes in temperature or humidity, hazardous or moving equipment, unprotected heights, and loud noises.
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NECESSARY QUALIFICATIONS
Education:
Technician I: Must have a High School diploma or GED
Technician II: Must have a Medical Billing and Coding Certificate or certification in a related field.
Technician III: Must have an Associate’s Degree or higher in Business Administration or Hospital Administration or a related field.
Experience:
Technician I: Must have minimum of one (1) year experience related to medical, dental, and/or pharmacy billing and operations, and/or medical and dental coding, and/or patient access management, and knowledge of human anatomy and physiology and medical terminology.
Technician II: Must have minimum of three (3) years of experience related to medical, dental, and /or pharmacy billing and operations, medical and dental coding, or patient access management and knowledge of human anatomy and physiology and medical terminology.
Technician III: Must have five (5) or more years of experience and in-depth knowledge related to medical, dental, and/or pharmacy billing and operations, medical and dental coding, or patient access management, and knowledge of human anatomy and physiology and medical terminology.
Other Skills and Abilities:
A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate success in each one of the following areas:
- Positive working relationships with others
- Possession of high ethical standards and no history of complaints
- Reliable and dependable; reports to work as scheduled without excessive absences
- Completion of and above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the job
- Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job
- Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job
- Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading or incomplete information, as determined by TCRHCC.
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