Home

Billing Specialist

Crawford County Memorial Hospital
Denison

Job Description

Hours:

Day shift- 8:00 am - 4:30 pm

Essential Duties and Responsibilities:

  • Maintains a working knowledge of applicable Federal, State and local laws and regulations, the Compliance Accountability Program, Code of Ethics, as well as other policies and procedures Insurance billing and follow-up
    • Billing through hospital system of Medicare, Medicaid and Commercial Insurance and follow-up on unpaid accounts according to hospital payment timelines.
  • Monitors computer for credit notes, late charges and other account information. Ensures the combination of accounts as required by each third-party payer. High amount of telephone usage in all aspects of the job.
  • Verifies primary diagnosis code is billable and that all revenue centers requiring CPT codes have and appropriate code present.
  • Evaluates ledgers and face-sheets to verify necessary information for billing is present and accurate.
  • Is able to analyze the need for additional information and access the Clinical Medical Records Department, physician’s office, or Social Security Administration to ensure the information is complete.
  • Assesses the new claims report for errors. Notifies affected departments and makes credit and charge adjustments as necessary. 
  • Demonstrates ability to prepare the UB-92 claim report.
  • Prepares the HCFA 1500 claims for physician’s services by editing the claim.
  • Enters credit notes and billing information for each claim billed. Adds insurance carrier codes for all 1500 claims if necessary and places them in the proper order. 
  • Responsible for the distribution of paper claims and verifying electronic transmission.
  • Performs Series Accounts billing in a timely manner. Insures procedures are followed to eliminate denied claims due to duplicate services dates, etc.
  • Rebills claims with late charges in a timely manner.
  • Prepares a weekly billing productivity log for statistical purposes.
    • Assists in follow-up of unpaid claims for denied claims by helping analyze the information available.
    • Regular attendance at assigned physical location and time.
    • Answers department telephones appropriately and handles routine questions involving billing. Refers calls to credit department when appropriate.
    • Adheres to established procedures for billing Medicare secondary claims to comply with HCFA requirements for Medicare Providers.
    • Demonstrates ability to access the Medicare FSS for review of pending claims, facilitating the processing and payment of these claims.
    • Reviews and evaluates Medicare denials for claims previously submitted.
    • Knowledgeable of Iowa or Nebraska Medicaid denial process. Rebills according to procedure within the time lines established.
    • Evaluates Medicare admissions information on FSS to ensure accuracy, makes corrections as necessary.
    • Makes good use of time through good organization and prioritizing work projects.
    • Demonstrates ability to use CPSI system to batch, download, and transmit claims as necessary.
    • Demonstrates ability to consistently process claims according to department standards for quality and volume of claims billed weekly.
    • Maintains confidentiality of information pertaining to clients, physicians, employees, and CCMH business
  • Also assists in the business office which includes the following Admission, Dismissals, Switchboard, Billing and follow-up, and Specialty Clinic preparations.
  • Demonstrates values and behaviors according to Values Statement.

 Required Knowledge, Skills, and Abilities:

  • High school graduation required with emphasis in commercial courses preferred.
  • One to two years prior hospital/medical office experience required. Prior coding experience and knowledge of medical terminology preferred.
  • Must be able to type 50-60 w.p.m. and operate CRT and standard office machines.
  • Must have ability to function under stress. Must possess emotional maturity to maintain good relationships in multiperson office.
  • Must be able to comprehend and retain. Requires some judgment to analyze and make decisions.
  • Accuracy in data entry to ensure correction information through the billing process.

 

 

Qualifications

Skills

 

Preferred

Microsoft Word
Intermediate
Microsoft Excel
Intermediate
General Computer Knowledge
Intermediate

Education

 

Preferred

High School or better in General Business.

Experience

 

Preferred

1-2 years: Prior hospital / medical office experience with insurance billing experience preferred preferred.

Qualifications

Education

 

Preferred

High School or better in General Business.

Experience

 

Preferred

1-2 years: Prior hospital / medical office experience with insurance billing experience preferred preferred.

Skills: Microsoft Word, Excel and General Computer knowledge

Apply Save