Position Overview:
Maintains reimbursement schedules and performs audits to ensure compliant use of billing codes resulting in appropriate reimbursement. Acts as a third party payer information resource; assisting the billing staff with payer specific issues; assisting the manager with identifying and implementing regulatory changes in an efficient and proactive manner. Appeals all denials and acts as a liaison between the department and clinical areas assisting with the communication of medical necessity requirements lost revenue due to denials etc. The position will ensure compliance with Federal and State rules and regulations. The position will also ensure that billing and reimbursement are in accordance with contracts.
MAJOR RESPONSIBILITIES JOB DUTIES AND PROJECTS:
1. Responsible for denial management tracking and reporting. Prepares action plans to reduce denials. Appeals denials when appropriate.
2. Responsible for maintaining reimbursement schedules and auditing collections to ensure they are in accordance with contract.
3. Monitors charge posting billing and collections operations to ensure that practices are compliant and resulting in clean claims and appropriate reimbursements.
4. Monitors receivable activity to ensure lowest receivable days possible as well as maximizing cash flow while maintaining highest compliance standards and excellent customer service.
5. Tracks and reports pre-bill errors.
6. Audits billing and reimbursements for compliance.
7. Acts as billing liaison for complaint claims submission. Assists the manager as a reference point for all questionable claims scenarios in the department. Responsible for researching and resolving regulatory claims issues.
8. Maintains department goals and objectives and implements policies and procedures for department operation.
9. Assists the manager with researching and disseminating billing regulatory changes.
10. Prepares financial reports on department's receivable activities.
11. Maintains open line of communication with manager and department to discuss account problems.
12. Provides billing education to employees in regard to billing guidance and regulations through department meetings one-on-one communication and written guidance.
13. Maintains accurate up-to-date policies and procedures for the assigned job duties.
14. Prepares analyzes and maintains data as required for regulatory reporting. Responsible for data preparation analysis system analysis and other fiscally related duties as assigned.
15. Communicates with third party payers regarding payment processing denial management regulatory changes and reimbursement models.
16. Serves on committees and attends meetings as necessary.
17. Attends educational workshops.
Education Requirements:
High school education or equivalent. Some college preferred.
Experience Requirements:
Billing experience required. Ability to audit a must. Excels in computer system operations including billing systems word-processing and spreadsheets. Demonstrates good verbal and written communication skills. Must have ability to analyze and prepare financial records. Must be detail oriented and be able to work in high-pressure atmosphere with constant change.
