Billing/Collector - Full-Time - AVALA Hospital - RH170, RH171

Summary

The Billing and Claims Analyst is responsible for a broad range of billing and collection processes related to managing the unbilled and uncollected revenue. Processes claims electronically in addition to hard copy as required by insurance carrier. Works to resolve all billing edits and communicates issues to appropriate department personnel in a timely manner.  Responsible for the collection processes on accounts in order to expedite claim processing and reimbursement.  Reviews denials and submits appeals following Medical LCD’s and NCD’s guidelines.  Assist with support in other areas as needed.

Essential Duties and Responsibilities

Billing                                                                                                                                                                   

• Verify patient billing information is correct prior to claim submission.
• Works to resolve all identified insurance requirement edits through the electronic billing system; ensures submitted claims meet payer’s guidelines.
• Communicates issues with patient access and facility departments.
• Monitors daily transmissions of all electronic claims to the clearing house.
• Daily works rebills when needed.
• Daily submits required paper billing to insurance carriers with required documentation, including secondary claims.
• Attach I-bills, MR to paper billing when required.
• Enter notes in the patient accounting system on all action taken.
• Adheres to state and federal billing guidelines and applies regulations in day-to-day billing practice.
• Adheres to HIPAA and PHI guidelines.
• Assists with other duties as assigned.

Claims Analyst

• Performs collection follow up on outstanding accounts and provides companies with any information that will allow them to expedite payment and processing of the claim.  Documents all efforts into computer software.
• Consistently identifies and resolves billing discrepancies to ensure and expedite reimbursement; works closely with billing and notifies billing of issues and problems with billing processes and companies; works all denials and files appeals when necessary to protect reimbursement.  Follows up until resolved.
• Works all insurance denial from all payers; document all denials and notifies Business Office Manager in a timely manner.
• Process patient and insurance refunds and attaches all pertinent documents for reference. 
• Review accounts for possible assignment and forwards qualified accounts to collection agency.
• Assist collection agency with questions on placed accounts.
• Reviews patient statement listing each week to identify any accounts that require a statement hold, and places hold when appropriate.
• Coordinates any accounts requiring a rebill with the biller.
• Answer patient inquires in a timely manner.
• Keeps updated on all contract terms and CMS regulations.
• Assist with billing questions as needed.
• Answering phones.                                                                                                                                          
• Courteous to visitors, patients, and physicians’ offices.
• Notifies Assistant Manager of complaints timely.
• Any other duties as assigned by Director, Financial Services.                             

Core Competencies

Action Orientation - Targets and achieves results, overcomes obstacles, accepts responsibility, establishes standards and responsibilities, creates a results-oriented environment, and follows through on actions.

Communications - Communicates well both verbally and in writing. Effectively conveys and shares information and ideas with others. Listens carefully and understands various viewpoints. Presents ideas clearly and concisely and understands relevant detail in presented information.

Creativity/Innovation - Generates novel ideas and develops or improves existing and new systems that challenge the status quo, takes risks, and encourages innovation.

Critical Judgment - Possesses the ability to define issues and focus on achieving workable solutions. Consistently does the right thing by performing with reliability.

Customer Orientation - Listens to customers, builds customer confidence, increases customer satisfaction, ensures commitments are met, sets appropriate customer expectations, and responds to customer needs.

Interpersonal Skills - Effectively and productively engages with others and establishes trust, credibility, and confidence with others.

Leadership - Motivates, empowers, inspires, collaborates with, and encourages others. Builds consensus when appropriate. Focuses team members on common goals.

Teamwork - Knows when and how to attract, develop, reward, and utilize teams to optimize results. Acts to build trust, inspire enthusiasm, encourage others, and help resolve conflicts and develop consensus in creating high-performance teams.

Professional Requirements

• Meets dress code standards and adheres to policies.
• Completes annual education requirements.        
• Maintains regulatory requirements.       
• Maintains patient confidentiality at all times.     
• Reports to work on time and as scheduled, completes work within designated time.
• Wears identification while on duty, uses computerized punch time system correctly.       
• Completes in-services and returns in a timely fashion.    
• Attends annual review and department in-services, as scheduled.
• Attends staff meetings annually or reads and returns all monthly staff meeting minutes.
• Represents the organization in a positive and professional manner.
• Actively participates in performance improvement and continuous quality improvement (CQI) activities.
• Complies with all organizational policies regarding ethical business practices.      
• Communicates the mission, ethics and goals of the hospital, as well as the focus statement of the department.
• Promotes professional growth of subordinates by sharing knowledge and/or directing them to sources if information appropriate to given situation. Utilizes journals, books, etc. to learn and/or improve new techniques and equipment.
• Assists other staff members in performing any duty that enhances the delivery of patient care.

Regulatory Requirements

• High school diploma.

Skills

• Ability to communicate effectively in English, both verbally and in writing.
• Basic computer knowledge.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. This position is very active and requires repetitive motions, standing, walking, bending, kneeling and stooping all day. The employee must frequently lift or move items weighing up to 20 pounds. 

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