RCM Billing Specialist Team Lead

Description

This position will be responsible for scrubbing claims for accuracy in billing. The Scrubbing department will be charged with retrieving, approving, batching, and scrubbing claims to avoid errors that would cause the claim to reject or deny.

Duties include, but are not limited to, the following

• Retrieve claims from the Electronic Medical Records (EMR).
• Review EMR documentation where appropriate.
• Diagnosis coding for known appropriateness for the visit and for the carrier guidelines.
• Ensure charges, diagnosis pointers, modifiers, and NDCs (if necessary) are correct and there are no duplicates. 
• Ensure that the correct provider, site, insurance, filing type, and referrals/authorizations are selected.
• Work exceptions caught by system scrubbing.
• Work Front End Rejections.
• Communicate with appropriate person(s) with any questions or concerns.  This could include - but not limited to - hub personnel, provider, coding team and others within the CBO.
• Approve and batch claims.
• Periodically check for Unretrieved Charges.
• Communicate with others of observed trends.
• Recognizing the need for additional scrub rules based on trends.
• Other
• Ability to work independently and as part of a team with the capability to shift between projects while maintaining productivity and efficiency.
• Maintain patient confidentiality; comply with HIPAA and compliance guidelines established by the practice.
• Maintains detailed knowledge of practice management and other computer software as it relates to job functions.
• Attends all meetings as requested including regular staff meetings.
• Attends Medicare and other continuing education courses as requested.  Pursue and participate in education to remain current with changes in the Healthcare industry.
• Performs any additional duties as requested by RCM Leadership.

Lead Function

• Assist RCM Supervisor by overseeing the day-to day operations.
• Coordinate training, setting expectations for the department, and provide feedback on department staff.
• Provide constructive feedback to management concerning the operations and ideas of improvement for the department.
• Monitor charge retrieval process to ensure claims are being transmitted on a daily basis.
• Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.
• Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline.

Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards and policies.

Qualifications

• High school diploma, or equivalent, required.
• Minimum eighteen months experience in a medical office reimbursement department.
• Comfortable using email and interacting with Internet applications.
• Working knowledge of MS Excel, MS Word, and understanding of practice management software.
• Basic understanding of Explanation of Benefits forms, claim forms and the insurance billing process.
• Strong written and verbal communication skills.

Physical demands are moderate with occasional lifting of items weighing approximately 20-30 pounds.  Position requires prolonged sitting, some bending, stooping, and stretching. Working under stress and use of telephone required. Good eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment is also required.  Employee must have normal range of hearing and vision must be correctable to normal range to record, prepare, and communicate appropriate reports.