KEY RESPONSIBILITY AREAS (KRA)
- Take the data provided by the medical coders and use it to compile and submit claims to insurance companies and then subsequently bill patients
- Navigate through various insurance rules and regulations to reduce A/R days.
- Understand the nuances of various types of insurance carriers along with their claim requirements.
- Provide successful follow-up efforts for A/R including the appeals process for denied claims.
- Implement best practices for insurance and patient collections while maintaining excellent public relations.
- Reduce risk by understanding Fair Debt collection practices, professional courtesy regulations, clean claims and timely filing guidelines, refund requirements, and other regulations.
- Use data and reports as indicators for potential improvement areas.
- Collect delinquent accounts by establishing payment arrangements with patients, monitor payments and also follow-up with patients when/if payment lapses occur.
- Maintains Medicare bad-debt cost report by tracking billings; monitoring collections; compiling information.
- Initiates claims against estates by monitoring deaths and unpaid accounts.
- Secures outstanding balance payments for care of hospital employees by establishing payroll deductions; obtaining signatures for automatic transfers.
- Maintains work operations by following policies and procedures; reporting compliance issues.
- Protects hospital value by keeping collection information confidential.
- Adheres to professional standards, hospital policies and procedures, federal, state and local requirements."
GENERAL RESPONSIBILITIES
- Ensures strict confidentiality of clients, patients, and financial records to comply with PHI, ePHI and HIPAA
- Review, acceptance, and understanding of workplace culture statement
- Responsible to comply with organization's policies and procedures, adhere to Code of Conduct
- Ensures to complete the required compliance training modules and report any observations of non-compliance
- Follow-up the claim to ensure the practice receives reimbursement for the work the providers perform. A knowledgeable biller can optimize revenue performance for the practice.
- Regularly communicate with physicians and other healthcare professionals and its representatives to clarify diagnoses or to obtain additional information.
- Must understand how to read the medical record and, like the medical coder, be familiar with CPT®, HCPCS Level II and ICD codes.
- Assembles all data concerning the bill. This can include charge entry, claims transmission, payment posting, insurance follow-up, and patient follow-up.
- Other duties that may be assigned