Billing, Contract Management, Denials Management, Diagnosis-Related Group (DRG), Document Imaging, HIPAA (Health Insurance Portability and Accountability Act), Healthcare Common Procedure Coding System (HCPCS), Hospital, Hospital Systems, ICD-10, Information Technology & Information Systems, Insurance, Medical Records, Problem Solving Skills, Resolve Customer Issues, Team Player, Time Management
- Ensure account accuracy.
- Review daily claims to ensure submissions are clean and timely.
- Monitor charges/modifiers/CPT-4s/HCPCS/payments/DRGs/ICD-10 coding.
- Review outstanding accounts using ATB/queues/payments reports/halt report/electronic billing edits/credit balances.
- Submit timely and accurate adjustments/notes/patient balance transfers and medical record requests.
- Work with management team and notifying of notifying of issues that arise with payors/departments/etc
- Resolve account issues and problem solving independently whenever possible.
- Use technology provided (including hospital information system, contract management system, electronic billing system, payer websites and document imaging system.)
- Manage denials and appealing administrative claims.
- Understand denials and how they should be handled.
- Send clinical denials and downgraded claims to appropriate parties to ensure timely appeal.
- Ensure claims denied at time of billing are distributed to appropriate parties for review.
- Update and correct accounts with assistance of originating departments (charges/authorizations/insurance issues).
- Follow departmental and hospital policy and procedure (this includes HIPAA guidelines and Federal guidelines).
- Understand payor contracts and billing guidelines; revenue codes and payor specific requirements; and payor/plan codes.
S
Saint Peter's Healthcare System Inc