What are the responsibilities and job description for the Tift Regional Health System is hiring: Acute Claim Editor in Tifton position at Tift Regional Health System?
DEPARTMENT : PATIENT FINANCIAL SERVICES
FACILITY : Medical Office Building
WORK TYPE : Full Time
SHIFT : Daytime
HOURS : SUMMARY :
Claims Editor is responsible for billing insurance companies, assuring billing guidelines remain current for all hospital, and hospital based physician billing within their area of responsibility. Performs other work associated with the billing process.
RESPONSIBILITIES :
- Claim Scrubber - UB & 1500s; checks errors, makes corrections and sends to Payer.
- Download claims, Review combined, Failed Claims (CRC), and 72-hour Reports daily.
- Verifies bridge routines are updated in EPremis and working properly.
- Corrects errors when a payer returns claims and re-submits claims to the payer.
- Hold Report (daily); checks status of accounts on hold and determines whether to keep on hold or release.
- Sends applicable Medical Records and invoices as appropriate for the claim.
- Checks accounts for secondary insurance after primary payer has sent remittance and adjusts balances accordingly.
- Verifies claims are received by the payer.
- Ensures Pre-certs, ABNs, and documentation is submitted as appropriate.
- Documents all activity in computer in order to meet time filing limits.
- Keys all follow up activity into computer on each account.
- Assist staff in the department on rules and regulations of the payers.
- Answers questions from patients or guarantors regarding insurance status.
- Researches patient accounts for information requested by management.
- Keeps abreast of pertinent federal, and state regulations and laws and Tift Regional Health System, Inc. ("TRHS") policies as they presently exist and as they change or are modified.
- Understands and adheres to : TRHS' compliance standards as they appear in TRHS's Corporate Compliance Policy, Code of Conduct and Conflict of Interest Policy; and HIPAA and TRHS policies regarding privacy and security of protected health information.
- Demonstrates the ability to perform tasks that meet the age-specific requirements of the persons, patients, vendors, and staff that the employee is charged to interact with as required by the position.
- Offers suggestions on ways to improve operations of department and reduce costs.
- Attends all mandatory education programs.
- Improves self-knowledge through voluntarily attending continuing education / certification classes.
- Maintains required competency levels as identified in written exams, skills checklists, skills labs, annual safety and health requirements as well as service excellence education hours requirements.
- Cross-trains in order to better assist co-workers and to provide maximum efficiency in the department.
- Volunteers / participates on hospital committees, functions, and department projects.
- Manages resources effectively.
- Reports equipment in need of repair in order to extend life of equipment and removes malfunctioning equipment out of service with timely reporting to the appropriate personnel.
- Makes good use of time so as to not create needless overtime.
EDUCATION :
OTHER INFORMATION :
One (1) year prior experience in billing of third party insurance for facility and / or professional services required.
Southwell / Tift Regional Health System, Inc. is an Equal Opportunity Employer.
