What are the responsibilities and job description for the Billing & Reimbursement Specialist I, TUCBH position at Tulane University Staff?
The Tulane University Center for Brain Health (TUCBH) is a clinical care and research center for Traumatic Brain Injury (TBI), Physiological conditions, and Behavioral Health (BH) conditions such as post-traumatic stress, depression and anxiety. The primary focus of the TUCBH is to care for former military personnel who have separated from active duty, with special consideration for those who were separated with "Other Than Honorable" or "Dishonorable" discharge status due to TBI or BH conditions.
The Billing and Reimbursement Specialist is responsible for the timely verification of medical insurance benefits through telephonic and electronic communication with private insurance companies, Medicare, and Medicaid, TriCare, and VA to obtain benefit information and determine insurance compatibility with health-care provider programming. This position supports program sustainability by ensuring all prior authorization work is completed prior to patient arrival.
Responsibilities include coordination and communication with patients regarding their insurance benefits and medical providers programs, re-verifying existing patient insurance coverage, and determining if an insurance benefit plan considers selected products appropriate based on patient need. Obtains pre-certification or authorization, verify insurance for all patients, including support for those who may be underinsured or uninsured.
Monitors incoming and outgoing referrals. Follows internal referral management policies and procedures. Answers telephones, directs calls, takes and delivers messages in Epic.
Ensures excellent customer service by consistently demonstrating a caring, positive, professional, and helpful disposition with all customer relations. Performs miscellaneous duties as needed to support administrative operations of the practice.
- Familiar with governmental billing rules and regulations and other third party billing requirements.
- Knowledge and experience with ICD9 and CPT4 coding.
- Experience with personal computers, word processing (micro soft office skills).
- Excellent oral and written communication skills.
- Must be able to work independently and meet deadlines.
- Well developed judgment and decision-making abilities.
UNIVERSAL PERFORMANCE STANDARDS :
Completes all assigned duties by established deadlines and in accordance with established or defined protocols, policies, and procedures. Apprises supervisor of issues that might impede timely completion of assigned duties and / or departmental projects.
Exercises sound judgment and discretion at all times and maintains cooperative working relationships with both internal and external constituencies and co-workers.
Exhibits a willingness to perform other duties as requested or required efficiently and timely. Complies with all policies and procedures as stipulated in the Tulane Staff Handbook.
REQUIRED BACKGROUND CHECK : MS requires that TUMG conduct monthly background checks for employees and vendors having access to Personal Health Information (PHI). TUMG conducts background checks through Sanction Check. Sanction Check searches Office of Inspector General (OIG) and General Services Administration (GSA) - System for Award Management (SAM) databases for compliance.
