Specialty Biller (Full Time) - Patient Financial Services

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    "ExternalDescriptionStr": "<p><strong>Staff Position Description</strong></p><p><strong>Position Title: </strong>Specialty Biller&nbsp;</p><p><strong>Position Purpose:</strong></p><p>All KHI employees are expected to perform their respective tasks and duties in such a way that supports KHI’s vision of providing the region’s best clinical care and patient service through an environment that fosters respect for others and pride in performance.</p><figure class=\"table\"><table><tbody><tr><td width=\"719\"><strong>This position is responsible for processing claims to ensure the accurate and timely billing of services.</strong></td></tr></tbody></table></figure><p><strong>Key Responsibilities</strong></p><figure class=\"table\"><table><tbody><tr><td width=\"719\"><p>I. <u>Service and Process Improvement:</u></p><p>A. Provides excellent customer service and adheres to the Behavioral Expectations Agreement and the mission, vision, and values of KHI<strong>.</strong></p><p>B. Assists in process improvement to bring about greater billing efficiency and accuracy.</p><p>C. Participates in business division meetings, performance improvement activities and committees as assigned. Communicates issues with incorrect or unclear information within training materials.</p><p>D. Utilizes Issues Log or other requested means of communication regarding issues, when necessary.</p><p>E. Performs other job duties, as assigned, to help meet the team’s goals and objectives.</p><p>II. <u>Accuracy:</u></p><p>A. Reviews UB04s, CMS 1500s, and/or itemized statements for completeness, efficiency, and accuracy.</p><p>B. Reviews claims for reasonableness of charges and obtains supporting medical documentation for claims when necessary.</p><p>C. Contacts employers, payers, and/or patients for updated claim information.</p><p>D. Bills clean claims for Acute and Ambulatory Medicare, Home Health, Hospice, Corporate, Indian Health, and/or Liability services.</p><p>E. Bills secondary insurance, when appropriate.</p><p>F. Works rejection reports, including correction of demographic information, to ensure appropriate billing.</p><p>G. Works rejection reports to re-bill claims accurately.</p><p>H. Appropriately works the accounts receivable and denials.</p><p>I. Adheres to policies and procedures to achieve departmental and hospital goals.</p><p>J. Reviews training materials periodically to ensure accuracy and compliance with updated billing procedures.</p><p>K. Uses Direct Data Entry (DDE) to resolve billing issues for Medicare claims.</p><p>L. Meets established accuracy metrics as communicated by management. Metrics may differ depending on biller level.</p><p>III. <u>Timeliness:</u></p><p>A. Understands contracts and payer specific guidelines in order to ensure timely follow up to avoid untimely denials and delays in cash flow.</p><p>B. Maintains and facilitates communication within the business and clinical divisions.</p><p>C. Completes timely follow up on accounts, resolved denials, and/or other correspondence.</p><p>D. Responds professionally and within appropriate time frames to telephone, e-mail, and task inquiries.</p><p>IV. <u>Productivity:</u></p><p>A. Meets productivity standards for sending out bills daily, working billing reports, and correcting rejections efficiently.</p><p>B. Meets productivity standards for working outstanding accounts and denials in an effort to achieve claim resolution.</p><p>C. Meets established productivity expectations as communicated. Metrics may differ depending on biller level.</p></td></tr></tbody></table></figure><p><strong>Qualifications&nbsp;</strong></p><figure class=\"table\"><table><tbody><tr><td width=\"719\"><p>· High school graduate or equivalent required.</p><p>· One (1) year of medical billing and/or collections experience required.</p><p><u>Level I</u>:</p><p>· Demonstrates ability to communicate effectively with all types of customers, to manage multiple priorities and tasks, and to maintain attention to detail.&nbsp;</p><p>· Demonstrates knowledge of and ability to use computer hardware and software applications.&nbsp;</p><p>· Demonstrates improving proficiency in billing by meeting required departmental standards. These standards will be measured by formal and informal audits.</p><p><u>Level II:</u></p><p>In addition to meeting the qualifications for a Level I Specialty Biller, a Level II Specialty Insurance Biller must:</p><p>· Provide verification of completion of the Core and Specialty Training Program.</p><p>· Demonstrate advanced proficiency in billing by meeting required departmental standards. These standards will be measured by formal and informal audits.</p><p><u>Level III:</u></p><p>In addition to meeting the qualifications for a Level II Specialty Biller, a Level III Specialty Insurance Biller must:</p><p>· Provide verification of completion of the Core and Specialty Training Program.</p><p>· Demonstrate advanced proficiency in billing by meeting required departmental standards. These standards will be measured by formal and informal audits.</p><p>· Demonstrate the ability to effectively train and lead other employees in a manner which meets the mission, vision, and values of KHI.</p></td></tr></tbody></table></figure><p><strong>Preferences&nbsp;</strong></p><figure class=\"table\"><table><tbody><tr><td width=\"719\">Working knowledge of Medicare billing practices in a Hospital, Physician Clinic System, Home Health, and/or Hospice Setting.</td></tr></tbody></table></figure><p><strong>Date Staff Position Description Created / Revised: </strong>7/5/2018</p>",
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