The work involves performing hospital or professional billing functions, collecting and accounting for monies received, and denials prevention analysis in the Hospital Billing Department for the Erie County Medical Center Corporation. The incumbent submits and follows-up all billing and claims for the facility and performs analysis to identify denials, appeals and corrective actions to maximize reimbursements. Work is performed under the direct supervision of higher level administrative staff. Supervision is not a function of this position. Does related work as required.
TYPICAL WORK ACTIVITIES:
Performs all duties in accordance with Medicare, Medicaid, governmental and third party payer and patient self-pay billing guidelines, rules and regulations and ensures compliance with Health Information Portability and Accountability Act (HIPPA) regulations;
Operates electronic billing system;
Reviews patient medical bills for accuracy and completeness upon submission to payer;
Contacts patients, if necessary, to obtain information and assistance in processing claims;
Documents and updates patient accounts with correct and accurate information;
Follows up on unpaid or incorrectly paid claims to ensure correct and timely reimbursement;
Performs daily voucher breakdown to ensure timely follow-up is completed;
Prepares refunds for credit balances;
Prepares itemized bills and statements to be rendered;
Receives payments and set-up patient payment plans as required;
Analyzes and acts on system generated reports;
Bills and follows-up on payer and governmental audits;
Performs and monitors internal and external audits;
Reviews, completes and correctly files correspondence requests;
Monitors insurance denials; contacts insurance companies to resolve and recover denied claims;
Evaluates unresolved third party claims and processes appeals with insurance companies to obtain proper reimbursement;
Collaborates with internal and external departments to ensure correct billing practices and accurate reimbursement and to resolve billing issues;
Serves as a resource for problem solving for registration, demographic and insurance errors;
Tracks trends for denials and underpayments to facilitate process improvements; recommends quality and/or improvement initiatives;
Assists customers, both external and internal at the cashier's window;
Receives and downloads electronic funds transfer (EFT) payments;
Maintains and updates various cash logs, ensures cash received and posted is balanced, prepares daily deposit;
Receives mail for posting;
Posts various payments and adjustments from insurance companies and patients;
Trains new staff members and current employees on new procedures;
Attends and participates in office meetings to review problems and issues and to review, identify and develop process improvements.
FULL PERFORMANCE KNOWLEDGES, SKILLS, ABILITIES AND PERSONAL CHARACTERISTICS:
Thorough knowledge of hospital and professional services billing, terminology and procedures; good knowledge of hospital and professional services, charges, revenue and diagnosis codes; working knowledge of Medicare, Medicaid, governmental and third party payer and patient self-pay billing guidelines, rules and regulations; working knowledge of HIPAA; ability to perform basic arithmetic computations; ability to use computer applications including Word, Excel and billing systems; ability to analyze reports; ability to prepare statements and bills; ability to communicate effectively, both orally and in writing; ability to carry out oral and written instructions; ability to train staff; ability to work both independently and in a team setting; ability to multi-task; accuracy; neatness; tact; courtesy; capable of performing the essential functions of the position with or without reasonable accommodation.
A.) Graduation from a regionally accredited or New York State registered college or university with an Associate's Degree in Business, Finance, Accounting, or closely related field and one (1) year of experience in hospital or healthcare billing; or:
B.) Graduation from high school or possession of a high school equivalency diploma and three (3) years of experience in hospital or healthcare billing; or
C.) An equivalent combination of training and experience as defined by the limits of (A) and (B).
NOTE 1: Completion of a certificate program in Medical Billing or Medical Reimbursement or Professional/Physician Billing may be substituted for one (1) year of hospital or healthcare billing experience.
NOTE 2: Verifiable part-time and/or volunteer experience will be pro-rated toward meeting full-time experience requirement.