Under general supervision of the Supervisor of Billing, the Billing and Collections Representative completes daily billing and AR follow up for assigned scope, in accordance with established criteria. Includes the daily reconciliation of assigned reports and controls to ensure claims are billed accurately and timely. Coordinates follow up with providers, clinic, and hospital staff as needed. Serves as the first point of contact for customer calls and inquiries regarding billing and claim payment.
Every effort has been made to make this job description as complete as possible. However, it in no way states or implies that these are the only duties the incumbent will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or is a logical assignment to the position.
1. Resolves daily billed claim edits and rejections: target Clean Claim rate of 95% or greater:
2. Resolves denied claims: target denial rate of < 2% of total net revenue. Identify and resolve recurring payer-specific claim delays.
3. Identify and resolve recurring provider/clinic-specific claim delays: registration demographic profile, eligibility and Iplan assignment, authorization/pre-certification/referrals, medical necessity and/or ABN, charge entry and coding accuracy.
4. Performance Improvement Opportunities: Compiles information and contributes to the trending of Bill Holds and Denials for performance improvement by Provider, by Payer & by Reason/ Reason Code.
5. Achieves daily targeted individual productivity and performance outcomes for: daily productivity, Clean Claim submission rate, & quality assurance.
6. Provides backup as needed to the Scheduling and Registration staff in the Rural Health Clinic by answering phones, scheduling, and performing patient registration.
7. Abides by the HMH Legal Compliance Code of Conduct.
8. Maintains a safe work environment and reports safety concerns appropriately.
9. Maintains confidentiality and appropriate handling of PHI.
10. Performs all other related duties as required and assigned.
Requirements
Education: High school diploma or GED required. Graduate of a formal billing/coding program required.
Experience: Five years of business office experience in a healthcare setting required.
Required Skills: Excellent interpersonal, customer service, problem solving, and written and oral communication skills. Working knowledge of CPT codes and ICD-10 codes.
Benefits