Billing Specialist, RMF Revenue Cycle

DHR Health - US:TX:Edinburg - Days

Summary:

MISSION STATEMENT:

Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time.

VISION:

Our Vision is to create a world-class health system to advance medicine and increase access for the communities we serve by empowering caregivers to heal through compassion, knowledge, innovation, integrated care and excellence.

POSITION SUMMARY:

This position is responsible for the collecting and scanning of professional charges to revenue cycle department for charge entry, over the counter collections, financial activities of all patient accounts to include but not limited to all of the following: cashiering, bank deposits and reconciliation, posting of cash, scanning, collections, providing excellent customer service on bills of those patients calling or stopping by the department and provides explanation for any inquiries.

• POSITION EDUCATION/QUALIFICATIONS :

• High School/GED preferred
• Medical Office Specialist certificate, preferred
• Excellent customer service skills
• Computer skills required with knowledge of Microsoft Office suite, Internet
• EMR experience preferred
• Good written and verbal communication skills required
• Excellent customer service skills
• Bilingual – English/Spanish preferred

JOB KNOWLEDGE/EXPERIENCE :

• Two (2) years experience in a physician or hospital business office
• Experience working with Excel spreadsheet is required

Responsibilities:

POSITION RESPONSIBILITIES:

• Billing Preparation:

Prepares & scans clinic visits batch in the following order :

• • Billing Log Cover Sheet
  • Patient Schedule (should equal the number of billable visits)
  • Sign-In Sheet if not able to get a schedule out of the legacy system
  • Daily Deposit Summary Report, (Needs the signature of the person completing the form and management)
  • Bank Deposit Slip
  • Bank Deposit Confirmation
  • Paragon payment batch report
  • Daily reconciliation per batch, the reconciliation must match the total amount collected for the patients included in the batch, POA and PPS.
  • Credit Card Settlement report or credit card strip
  • Payment tracking log if not on Paragon
  • If the patient is Self-Pay office staff must include the promissory note (calculator form), specify the patient responsibility and if the payment was in full.
  • Super bill diagnosis and CPT codes will be linked using a numerical system of (1-1, 2-2, 3-3, 4-4, etc.)
  • If a Local Coverage Determination (LCD) exists, confirm a payable diagnosis is documented on the super bill.
  • Following each super bill should be the corresponding Demographic Sheet/Face sheet with Patient Address and Insurance Information
  • Demographic Sheet should also include the Authorization# or No Authorization Required documented.
  • Referral forms for patients seen for consultation
  • Copies of insurance cards for new patients or change of insurance
  • Confirm CPT code indicated on the super bill matches the CPT code authorized. Variations should be reported to management the same day and corrected prior to scanning the batch.
  • If you have updated either the insurance information or demographic information, stamp the SUPERBILL and/or FACE SHEET with the RED UPDATED stamp .
  • If incomplete batches are authorized for scanning then document the person authorizing.
  • Hospital E&M Visits
  • Verify the CPT Code, Appropriate Modifiers, Diagnosis and Referring Physician are documented on the Hospital Face sheet.
  • Scan the batch and label it according to the Standard Naming convention.
  • Example: Jones M C 01.01.17
  • Hospital Surgeries:
  • Print the Surgery Schedule (ORM Report if applicable)
  • Print the Face sheet with corresponding visit id from the coding summary, Operative Report and Hospital Coding Summary for each surgery/ procedure performed.
  • Circle all CPT codes performed by the surgeon
  • Diagnosis
  • For Outpatient Procedures the main diagnosis may be found in the Primary and Secondary Diagnosis listed on the coding summary, be sure to validate this with the Operative Report
  • For Inpatient Procedures the main diagnosis may be found within the body of the Coding Summary, be sure to validate this with the Operative Report
  • Please report any discrepancies to your manager. Coding Department must be made aware to update the coding summaries before submitting for billing.
  • Write any corresponding CPT modifiers next the CPT codes on the coding summaries.
  • If a Local Coverage Determination (LCD) exists, confirm a payable diagnosis is documented on the Hospital Coding Summary.
  • Run to the Encoder pro Physician Compliance Edit, and validate modifiers and LCDs.
  • Include the encoder pro screenshot with appropriate modifiers and LCDs in the batch.
  • Encoder pro screenshot is not require for Hospital EM code
  • Encoder pro screenshot is not require for Self pay bundles
  • Corresponding Authorization Forms are placed behind the Hospital Coding Summary.
  • If an Authorization Form is unavailable write the Authorization Number on the Hospital Face sheet (Example: AUTH# 123456789)
  • Review Daily Email titled “Authorized vs Billed Accounts”. If any of the patients being scanned appear on this list, a RETRO-AUTHORIZATION to change the CPT code authorized must be performed prior to scanning document for billing.
  • Scan the batch and label it according to the Standard Naming convention.
  • Example: Jones M H 01.01.17
  • Other Billing requirements :
  • Able to communicate with provider if there needs to be a CPT code, diagnosis or modifier clarification
  • Understands how to calculate Self-pays rates and process agreement form
  • Understands how to use ENCODER Pro
  • Understands Local Coverage Determination (LCD) and Medical Necessity
  • Knows the process for financial counseling referral to assist patient
  • Understands how to communicate payments on account (POA) , payments for pre-paid surgery (PPS)
  • Prepares deposit for Office Manager's review and daily deposit
  • Receives calls/visits from patients and assists staff with questions regarding payments
  • Uses TMHP portal to review patients who are pending Medicaid numbers in order to add those numbers to billings for hospital procedures in order to bill in a timely manner
  • Verifies insurance for any visit/procedure as needed, including pre certification and pre authorizations
  • Sends day end report, ensuring that all daily tasks are complete and ready for review
  • Meet with patients who have balances and need to make payment arrangements, as needed
  • Helps with any customer service questions relating to billing or balances owed as needed
  • Take messages from the voice mail, returning calls, and helping patients, as needed
  • Timely completion of daily, weekly and monthly reports
  • Auditing of office visit and procedure charges
  • Goes to the bank and/or post office as needed
  • Cross trained to all areas of the front office
  • Other duties as assigned
    

  LINES OF REPSONSIBILITY :

  (Chain-of-command)

  1. Patient Accounting Supervisor 2. Director of Professional Revenue Cycle 3. VP Revenue Cycle
  

  4. Chief Ambulatory Officer
  

Other information:

CUSTOMER SERVICE:

Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including: Compassion, Accountability, Respect, Excellence through Knowledge and Safety & Social Conscience.

AGE SPECIFIC :

Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret the appropriate information needed to identify each patient’s requirement relative to his or her age.

AMERICANS WITH DISABILITIES ACT: (ADA) :

A. Essential Duties : Indicated by bold print within performance standards, preceding individual numbered criteria.

The following table provides physical requirements that will be associated with, but not limited to, this position:

B. Working Conditions : The individual spends over 95% of his/her time in an air-conditioned environment with varying exposures to noise. There is protection from weather conditions but not necessarily from temperature changes. The position does have low exposure to malodorous, infectious body fluids from patients and some minimal exposure to noxious smells from cleansing agents.

C. Occupational Exposure: This position has minimal to no exposure to blood, body fluids, or tissues and is an OSHA Category III (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Person who performs these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid or to be potentially exposed in some other way.

D. Aptitudes : HIGH 1 2 3 4 5 6 LOW

Intelligence: General learning ability: The ability to “catch on” or understand instructions and underlying principles. Ability to reason and make judgments. 3

Verbal: Ability to understand meanings of words and ideas associated with them, and to use them effectively. To comprehend language, to understand relationships between words, and to understand meanings of whole sentences and paragraphs. To present information or ideas clearly. 3

Numerical: Ability to perform arithmetic operations quickly and accurately. 2

Spatial: Ability to comprehend forms in space and understands relationships of plane and solid objects. Frequently described as the ability to “visualize” objects or two or three dimensions, or to think visually of geometric forms. 2

Form Perception: Ability to perceive pertinent details and objects or in pictorial or graphic material to make visual comparisons and discriminations and see slight differences in shapes and shadings of figures and widths and lengths of lines. 3

Clerical Perception: Ability to receive pertinent details and verbal or tabular material. To observe differences in copy, to proofread words and numbers, and to avoid perceptual errors in arithmetic computation. 2

Motor Coordination: Ability to coordinate eyes and hands to fingers rapidly and accurately in making precise movements with speed. Ability to make a movement response accurately and quickly. 3

Finger Dexterity: Ability to move hands easily and skillfully. To work with fingers in placing and turning motions. 3

Manual Dexterity: Ability to move hands easily and skillfully. To work with hands in placing and turning motions. 3

Eye-Hand-Foot Coordination: Ability to move the hand and foot coordinately with each other in accordance with visual stimuli. 3

Color Discrimination: Ability to perceive and respond to similarities or differences in colors, shapes, or other values of the same or different color. To identify a particular color, or to recognize harmonious or contrasting color combinations, or to match color adequately. 3

I have read and reviewed my job description with my supervisor or designee and I understand the job I am expected to perform.

If applicable ____________ certification will be completed within _________ time frame of hire/transfer date.

Employee Signature: ________________________________ Date: ____________________

Transfer/Hire Date Effective: _______________________