What are the responsibilities and job description for the Billing Specialist position at San Carlos Healthcare Corporation?
The Billing Specialist reviews, adjusts and processes remittance advice forms by verifying accuracy and completeness of forms to ensure timely and accurate reimbursement by third party payers of services rendered.
ESSENTIAL FUNCTIONS (include, but not limited to the following)
- Daily, receives and reviews unprocessed patient visit report and copies of patient medical record to verify accuracy and completeness including, but not limited to: encounter information, ICD-9 and CPT procedure coding
- Data enters encounter information into patient billing system from source documents; generates UB92 or 1500 claim form based on visit type and procedures performed
- Consults with claims processors of third party payor regarding disputed and/or denied claims; provides copies of requested documents as needed to facilitate timely reimbursement of charges
- Reviews patient registration information for updates and/or changes to primary and secondary insurance coverage to ensure accuracy of billing
- Requests patient chart to verify system information and/or validate encounter documentation
- Receives and reviews daily, weekly and monthly production/error reports and EOB statements to identify errors; makes corrections and/or performs follow up as needed to ensure reimbursement of charges
- Prepares electronic transmission of claims, makes corrections to RPMS as needed to identify responsible insurance program based on provided service.
- Prepares adjustments to bills as needed, forwards to Manager for review and approval
- Maintains current all files of claims activities
- Participates in departmental orientation, on the job training and quality assurance programs/initiatives
- Participates in a variety of department and hospital educational programs to maintain current skill and competency levels; identifies and discusses performance or training needs with Supervisor
- Ability to regularly change priorities to accomplish tasks with frequent interruptions
- Ability to clearly communicate verbally, read, write, see and hear to perform essential functions
- Performs other duties as assigned.
