MAIN FUNCTION:

To enter both charges and payments for individual accounts and to process claims for Medicare, Medicaid and the third party carriers.  To perform collection duties as assigned.

 

DUTIES AND RESPONSIBILITIES:

 

Claims Processing

 

** 1.  Inputs batched charges with complete information in compliance with and exhibiting knowledge of carrier requirements.

 

** 2.  Assists in charge review process, demonstrating reimbursement experience including HCFA rules and regulations.

 

** 3.  Verifies the appropriate use of modifiers, dependent on carrier requirements.

 

** 4.  Processes billing to carrier in compliance with regulations.

 

** 5.  Processes payments from both carriers and patients.  Payments will come in batched format from offices.

 

** 6.  Researches credit balances and prepares refund requests where appropriate.

 

** 7.  Processes patient billing statements.

 

** 8.  Answers both patient and carrier correspondence in a timely fashion.

 

Receivable Management:

 

** 9.  Reviews aged trial balance with charges 60 days old and reworks as required to ensure payment.

 

** 10. Initiates and completes carrier reviews.

 

** 11. Receives phone calls from both patient and carriers which are to be handled in a professional and helpful manner.

 

** 12. Interviews patients who may visit the office for a better explanation, and this will be handled courteously, professionally and confidentially.

 

** 13. Performs collection activities as assigned.

 

Other:

 

14. Assists in development and maintenance of the billing procedure manual.

 

15.  Is responsible for attending all annual mandatory educational programs as  required by position.

 

16. Employee understands and demonstrates the importance of satisfying the needs of the customer/patient by interacting with him/her in a friendly and caring way, being attentive to the customer’s needs, both psychologically and physically, and by taking the initiative to maintain communication with the customer in order to provide a secure and pleasant experience with the Arnot Health.

 

17.  It is understood that this job description lists typical duties for the classification and is not to be considered inclusive of all duties which may be assigned.

 

EDUCATION:                                             

High school diploma or equivalent with additional course work and/or experience in accounting or bookkeeping required.

 

EXPERIENCE:                               

Reimbursement experience with Medicare B, Medicaid and other third party payers.  One to three years experience in billing. Current experience with ICD-9 and CPT-4 coding.  Demonstrated experience with billing for physician services.  Data entry experience.  Cash handling experience.

 

CARDIOPULMONARY RESUSCITATION (CPR) REQUIREMENTS:

No CPR required.

 

PHYSICAL DEMANDS:                

Light physical effort, typical officejob. 

 

EXPOSURE CATEGORY:                        

Category III.  Tasks that involve no exposure to blood, body fluid or tissues. And Category I tasks are not a condition of employment.

 

**  A.D.A. Essential Functions