Billing and Collections Specialist, RMF Revenue Cycle

DHR Health - US:TX:Edinburg - Days

Summary:

FLSA STATUS: Exempt Non-Exempt

MISSION STATEMENT:

Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time.

VISION:

Our Vision is to create a world-class health system to advance medicine and increase access for the communities we serve by empowering caregivers to heal through compassion, knowledge, innovation, integrated care and excellence.

POSITION SUMMARY:

This position is responsible for business office activities which include collection of accounts receivable, patient billing, customer service, cashiering, refunds/recoupments, appeals, and provides refunds for services to patients and third-party payers as needed. This position requires that at least three (3) of the functions above can be performed.

POSITION EDUCATION/ QUALIFICATIONS:

• High School Diploma/GED is required
  Comprehensive knowledge of healthcare reimbursement.
  Understands medical terminology
  Familiarity with EOB’s and RA’s
  Knowledge of Microsoft Office suite, working knowledge of Excel required.
  Excellent Customer Service
  Good written and verbal communication skills required
  Must be able to multi-task
  Ability to read, write and speak English
  Ability to communicate clearly and concisely with all levels of management
  Bilingual – English/Spanish, preferred
  Previous healthcare and hospital experience preferred.
  Ability to use the internet to obtain information from Third Party Payers or other sources is required.
  Requires working with minimal to moderate interruptions
  
  

  JOB KNOWLEDGE/EXPERIENCE:

  Previous healthcare and hospital experience preferred.
  
  
  • Communicates clearly and concisely and is able to work effectively with other employees, patients and external parties
  • Establishes and maintains long-term customer relationships, building rapport with other department staff
  • Demonstrate proficiency in Microsoft Office applications, be able to type at least 35 WPM, and good working knowledge of Excel is required.
  • Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly.
  • Medical Terminology, ICD – 10, Codes, CPT Codes, HCPCS code, Modifier knowledge required.
  Ability to use the internet to obtain information from Third Party Payers or other sources is required.
  Requires working with minimal to moderate interruptions
  
  
  • Occasional evening or weekend work may be required

Responsibilities:

POSITION RESPONSIBILITES:

• Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
• Staff are responsible for posting all charges within allowed time frame following HIPAA regulations, Data entry procedure, insurances policies and quality assurance procedures. Data entry staff are expected to post 100+ patients daily based on work assigned.
• Meet department KPI (Key Performance Indicators) expectations
• Daily Deposit Summary Report Validation, (Needs the signature of the person completing the form and management)
• Daily reconciliation per batch, the reconciliation must match the total amount collected for the patients included in the batch, POA and PPS, and run all necessary reports.
• Follow Self-Pay reconciliation process.
• Follow patient eligibility department protocol.
• Follow all necessary rules to ensure all mandatory segments are included in the medical billing software to ensure clean claim submission. (authorization, patient’s demographics, patient IDs, units, NDCs, etc.)
• Follow clearing house rejections department protocol
• Update insurance information based on insurance cards provided in the billing batch.
• Confirm CPT code indicated in the system queue matches medical record system orders. Variations should be reported to management on the same day.
• Follow quality assurance based on system custom rules such as LCD, CCI, authorizations, any missing information, units, NDCs, etc.
• Run Encoder pro Physician Compliance Edit/other available resources, and validate modifiers and LCDs as needed.
• Follow department email protocol.
• Staff are responsible for meeting daily production requirements based on assignment.
• Send end-of-day report, ensuring that all daily tasks are complete and ready for review
• Timely completion of daily, weekly and monthly reports
• Complete monthly reconciliation before end of month
• Cross trained in all areas of the revenue cycle department
• Assist with posting payments and identifying correct I-plan
• Download and post electronic remits and apply payments and adjustments as per I-plan.
• Research credit balances for accurate processing of refunds due to over payments and/or allowances requiring a correction in a timely manner.
• Prepares credit worksheet and processes all transactions required to request refund checks or to correct account balances.
• Transfers patient credit balances to outstanding accounts according to hospital policy and procedure and prepares letters of explanation concerning refund issued to third party payers and patients.
• Completes provider’s ERA applications for payers
• Document appropriate notes when requesting additional information from other co-workers or departments
• Ability to identify accounts that need insurance billing or rebilling
• Proficient in accessing information needed from medical records system.
• Request copies of medical records from HIM for any paper records
• Other duties as assigned.

Other information:

LINES OF REPSONSIBILITES:

(Chain-of-command)

1. Billing and Collections Supervisor 2. Billing and Collections Manager 3. Director of RMF Revenue Cycle 4. VP of RMF Revenue Cycle 5. CRO

CUSTOMER SERVICE:

Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including Commitment, Accountability, Respect, Excellence and Service.

AGE SPECIFIC:

Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret the appropriate information needed to identify each patient’s requirement relative to his or her age.

AMERICANS WITH DISABILITIES ACT: (ADA):

A. Essential Duties: Indicated by bold print within performance standards, preceding individual numbered criteria.

The following table provides physical requirements that will be associated with, but not limited to, this position:

B. Working Conditions: The individual spends over 95% of his/her time in an air-conditioned environment with varying exposures to noise. There is protection from weather conditions but not necessarily from temperature changes. The position does have low exposure to malodorous, infectious body fluids from patients and some minimal exposure to noxious smells from cleansing agents.

C. Occupational Exposure: This position has minimal to no exposure to blood, body fluids, or tissues and is an OSHA Category III (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Person who performs these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid or to be potentially exposed in some other way.

D. Aptitudes: HIGH 1 2 3 4 5 6 LOW

Intelligence: General learning ability: The ability to “catch on” or understand instructions and underlying principles. Ability to reason and make judgments. 3

Verbal: Ability to understand meanings of words and ideas associated with them, and to use them effectively. To comprehend language, to understand relationships between words, and to understand meanings of whole sentences and paragraphs. To present information or ideas clearly. 3

Numerical: Ability to perform arithmetic operations quickly and accurately. 2

Spatial: Ability to comprehend forms in space and understands relationships of plane and solid objects. Frequently described as the ability to “visualize” objects or two or three dimensions, or to think visually of geometric forms. 2

Form Perception: Ability to perceive pertinent details and objects or in pictorial or graphic material to make visual comparisons and discriminations and see slight differences in shapes and shadings of figures and widths and lengths of lines. 3

Clerical Perception: Ability to receive pertinent details and verbal or tabular material. To observe differences in copy, to proofread words and numbers, and to avoid perceptual errors in arithmetic computation. 2

Motor Coordination: Ability to coordinate eyes and hands to fingers rapidly and accurately in making precise movements with speed. Ability to make a movement response accurately and quickly. 3

Finger Dexterity: Ability to move hands easily and skillfully. To work with fingers in placing and turning motions. 3

Manual Dexterity: Ability to move hands easily and skillfully. To work with hands in placing and turning motions. 3

Eye-Hand-Foot Coordination: Ability to move the hand and foot coordinately with each other in accordance with visual stimuli. 3

Color Discrimination: Ability to perceive and respond to similarities or differences in colors, shapes, or other values of the same or different color. To identify a particular color, or to recognize harmonious or contrasting color combinations, or to match color adequately. 3

I have read and reviewed my job description with my supervisor or designee, and I understand the job I am expected to perform.

If applicable ____________ certification will be completed within _________ time frame of hire/transfer date.

Employee Signature: ________________________________ Date: ____________________

Transfer/Hire Date Effective: ________________________.