What are the responsibilities and job description for the PFS Billing Specialist position at Gibson Area Hospital?
GENERAL SUMMARY
The CBO Representative is responsible for accurate and timely billing and follow-up of all claims to ensure prompt payment from all payers. This would include all communication and research regarding patient accounts with all departments involved.
GIBSON AREA HOSPITAL & HEALTH SERVICES MISSION STATEMENT
To provide personalized, professional healthcare services to the residents of the Communities we serve.
PRINCIPLE DUTIES AND RESPONSIBILITIES
1. Run required daily reports for preparation of billing follow-up of patient accounts with all Medicare, Medicaid, Blue Cross, Commercial and all third parties.
2. Make Outgoing & Receive incoming calls and answer inquiries from patients, insurance companies and all other parties regarding the status and billing questions concerning claims.
3. Ensures appropriate, accurate/timely follow-up to all insurance companies based on established policies and procedures.
4. Review patient account information received from admissions and out patient registration. Identify any missing information and determine what avenue to take to insure timely follow-up.
5. Adequately responds to billing questions and provide clarification to customers.
6. Develops and maintains appropriate communication with insurance payers, outside agencies and internal departments.
7. Appropriately refers all non-routine issues to management for clarification.
8. Accountable for updating and preparing correspondence to customers and insurance payers as necessary.
9. Effectively communicate to customers needs with the appropriate level of
urgency.
10. Process and scan all EOBs/Correspondence received within 2 business days.
11. Re-bill and reprocess all Denials and Rejections ensuring all avenues are explored to resolve and issues with Insurance Payers.
12. Take incoming calls from patients regarding their insurance and billing.
13. Process all walk-ins
14. Resolution of Credit Balance reports Monthly.
15. Ability to work with fellow staff in a professional, courteous and respectful manner at all times.
16. All other duties assigned by Director of PFS or Executive Director of Revenue Cycle.
17. Work the denial program daily.
PHYSICAL REQUIREMENTS
1. Work requires knowledge of PCs keyboard, calculations, copy machine, printers and other office equipment.
2. Light level of physical effort required for a variety of physical activities to include lifting, standing and sitting at a workstation for up to four hours at a time.
Physical strength to perform the following lifting tasks:
Floor to waist - 10 pounds
Waist to shoulder - 10 pounds
Shoulder to overhead - 10 pounds
Carry 10 pounds for 15 feet
3. Work requires visual acuity necessary to observe and obtain information and use documentation.
4. Auditory acuity to hear others for purposed of fluent communication.
REPORTING RELATIONSHIP
Reports to the Director of Patient Financial Services.
EDUCATION, KNOWLEDGE AND ABILITIES REQUIRED:
1. General knowledge of mathematics and accounting principles.
2. Previous experience with billing forms required for different insurance plans.
3. Knowledge of Medical Terminology.
4. Familiar with the Legal and Ethical Compliance in charging and billing.
5. Previous experience in the policy and procedures of billing.
6. Requires analytical skills to evaluate claims for errors in billing and payment from payers.
7. Knowledge of patients rights.
8. Good communication skills to assist patients with billing questions and concerns.
9. AAHAM CRCS certification preferred.
INFECTION EXPOSURE RISK LEVEL
Category 3 - No Risk - Your job does not involve exposure to blood, body fluids or tissue. You do not perform or help in emergency medical care or first aid as part of your job.
WORKING CONDITIONS
1. Works in an office where there are relatively few discomforts due to dust or dirt. There is some exposure to print noises.
2. Will work in an office with co-workers where traffic may be constant, subjecting your work to interruptions, which can produce stress and fatigue.
The CBO Representative is responsible for accurate and timely billing and follow-up of all claims to ensure prompt payment from all payers. This would include all communication and research regarding patient accounts with all departments involved.
GIBSON AREA HOSPITAL & HEALTH SERVICES MISSION STATEMENT
To provide personalized, professional healthcare services to the residents of the Communities we serve.
PRINCIPLE DUTIES AND RESPONSIBILITIES
1. Run required daily reports for preparation of billing follow-up of patient accounts with all Medicare, Medicaid, Blue Cross, Commercial and all third parties.
2. Make Outgoing & Receive incoming calls and answer inquiries from patients, insurance companies and all other parties regarding the status and billing questions concerning claims.
3. Ensures appropriate, accurate/timely follow-up to all insurance companies based on established policies and procedures.
4. Review patient account information received from admissions and out patient registration. Identify any missing information and determine what avenue to take to insure timely follow-up.
5. Adequately responds to billing questions and provide clarification to customers.
6. Develops and maintains appropriate communication with insurance payers, outside agencies and internal departments.
7. Appropriately refers all non-routine issues to management for clarification.
8. Accountable for updating and preparing correspondence to customers and insurance payers as necessary.
9. Effectively communicate to customers needs with the appropriate level of
urgency.
10. Process and scan all EOBs/Correspondence received within 2 business days.
11. Re-bill and reprocess all Denials and Rejections ensuring all avenues are explored to resolve and issues with Insurance Payers.
12. Take incoming calls from patients regarding their insurance and billing.
13. Process all walk-ins
14. Resolution of Credit Balance reports Monthly.
15. Ability to work with fellow staff in a professional, courteous and respectful manner at all times.
16. All other duties assigned by Director of PFS or Executive Director of Revenue Cycle.
17. Work the denial program daily.
PHYSICAL REQUIREMENTS
1. Work requires knowledge of PCs keyboard, calculations, copy machine, printers and other office equipment.
2. Light level of physical effort required for a variety of physical activities to include lifting, standing and sitting at a workstation for up to four hours at a time.
Physical strength to perform the following lifting tasks:
Floor to waist - 10 pounds
Waist to shoulder - 10 pounds
Shoulder to overhead - 10 pounds
Carry 10 pounds for 15 feet
3. Work requires visual acuity necessary to observe and obtain information and use documentation.
4. Auditory acuity to hear others for purposed of fluent communication.
REPORTING RELATIONSHIP
Reports to the Director of Patient Financial Services.
EDUCATION, KNOWLEDGE AND ABILITIES REQUIRED:
1. General knowledge of mathematics and accounting principles.
2. Previous experience with billing forms required for different insurance plans.
3. Knowledge of Medical Terminology.
4. Familiar with the Legal and Ethical Compliance in charging and billing.
5. Previous experience in the policy and procedures of billing.
6. Requires analytical skills to evaluate claims for errors in billing and payment from payers.
7. Knowledge of patients rights.
8. Good communication skills to assist patients with billing questions and concerns.
9. AAHAM CRCS certification preferred.
INFECTION EXPOSURE RISK LEVEL
Category 3 - No Risk - Your job does not involve exposure to blood, body fluids or tissue. You do not perform or help in emergency medical care or first aid as part of your job.
WORKING CONDITIONS
1. Works in an office where there are relatively few discomforts due to dust or dirt. There is some exposure to print noises.
2. Will work in an office with co-workers where traffic may be constant, subjecting your work to interruptions, which can produce stress and fatigue.
