JOB SUMMARY
The purpose of this position is to help in rendering service to the patient population. The Medical Billing Specialist must be flexible and able to multi-task. The position must also be knowledgeable as to how their job functions are integrated with the other members of the staff to produce a coordinated effort and insure teamwork.
JOB REQUIREMENTS
Minimum Education
- High School Diploma or equivalent is required.
Minimum Work Experience
Prior hospital business office, physician office or insurance company claims processing required.Excellent phone communication skills requiredComputer skills required.Typing skills requiredMust be very detail orientedFUNCTIONAL DEMANDS
Physical Requirements
Sitting - =>
Walking - 1-15%
Standing - 1-15%
Bending / Squatting - 1-15%
Climbing / Kneeling - 1-15%
Twisting - 1-15%
OSHA Category
Minimal potential for direct exposures.
Visual and Hearing Requirements
Must be able to see with corrective eye wear.
Must be able to hear clearly with assistance.
Other Physical / Environmental Demands
Lifting - 0-50lbs, 50lbs or more with assistance
Carrying - 0-50lbs, 50lbs or more with assistance
Pulling - up to 100lbs
Pushing - up to 100lbs
ESSENTIAL FUNCTIONS
Assist patients in obtaining payment for services rendered.Provide positive customer service to the patients.Works edits in the Soarian and Quadax Computer systems and releases claims to be transmitted electronically.Print and mail paper claims with needed documentation such as itemized statements and / or medical records.Monitor unbilled claims in Quadax. Update insurance information as needed.Reviews accuracy of system edits and recommends changes.Demonstrate competency in utilizing the various computer systems and programs within the Business Office .Monitors the data quality obtained by Patient Access representativesBills secondary payors with documentation of primary payment.Collaborates with other departments when necessary - Medical Records and Information Systems in particular.Documents actions performed on each patient account appropriately.Participated in payor education programs and meets on site with payor representatives.Places calls to insurance companies and determines reason for claim not being paid.Determine what is required to approve claims for payment. Work assigned worklist in a timely manner.Visits insurance company web sites to determine claim status.Provides data required by insurance company to process claims, including rebilling primary and / or secondary claims.Submit requests for contractual adjustments as needed based on review of accounts.ORGANIZATIONAL EXPECTATIONS
T.J. Pledge
I Will Show Compassion
see all patients, family members, coworkers, physicians, and anyone else at T.J. as my customer.recognize that each and every interaction I have at T.J. Regional Health mattersshow kindness and compassion towards my customers at all timesbe sensitive to the personal and private needs of every customerI Will Cooperate With Others
maintain zero tolerance for abusive behaviorlisten and be willing to accept fault when I make a mistakenever underestimate the power of an apologyrefrain from blame and judgmentbring a sense of calm to stressful situationsI Will Collaborate With Others
value myself and every coworker as an equal part of one GREAT team working togethertreat others in a way that I would like to be treatedparticipate only in conversations that are courteous, respectful, and reflect positively on my teammates and T.J. Regional Healthfoster a calm and pleasant atmosphere, and refrain from gossip, rumors, and insultsspeak honestly, seek truth, and act with integrity towards my teammatesvalue the uniqueness and expertise that each team member contributes to the wholemeet the need of the moment, regardless of whether or not it is considered part of my jobI Will Communicate
smile - at everyonealways introduce myself, my role, and my purpose use body language, eye contact, and tone of voice that shows respect in every interactionfollow the 10 / 5 rule : always acknowledging people at 10 feet away with a smile and always greeting people at 5 feet awayescort any customer in need (visitors, patients) to their destinationI Will Adapt To Change
be a part of the solution when I am presented with a challengeembrace change and set the example for those around meaccept openly when there are changes that T.J. Regional and / or I have no control overmanage the expectations of others by explaining duration and next steps as often as neededI Will Be A Champion
serve with passionview myself as an owner of T.J. Regional Health and act accordinglytake responsibility for the physical appearance of T.J. Regional Health, including my work areago out of my way to daily thank and compliment my customers and coworkersdare to make a difference and be exceptionalconstantly try to improve myself and T.J. Regional Healthspeak positively about T.J. Regional, while at work and in public places outside of work
