Surgical Biller - Surgical Services - Full Time

Job Details

Description

Job Summary

Supports, and is responsible for incorporating into job performance, the Frederick Health mission, vision, core values and customer service philosophy and adheres to the Frederick Health Compliance Program, including following all regulatory requirements and the Frederick Health Standards of Behavior.

Under the direction of a supervisor, provides general oversight to the daily work flow for an assigned group of Patient Account Representatives, prioritizing the workload and referring problems to the supervisor. Provides input into evaluations and gives routine reports as required. As a working lead, performs the same duties as the team and is responsible for ensuring the daily operations of billing activity for all third party payers. Analyzes billing trends providing insight to resolving claim rejections to promote earliest possible cash recovery.

Example Of Essential Functions

• Examines denied and underpaid claims to determine reasons for discrepancies
• Communicates directly with payers to follow up on outstanding claims, resolve payment variances, and achieve timely reimbursement
• Provides payers with specific reasons for suspected underpayments and analyzes denial reasons given by payers
• Works with management to identify, trend, and address root causes of denials; helps pinpoint strategies for reducing A/R
• Maintains a thorough understanding of federal and state regulations, as well as specific payer requirements and explanations of benefits, in order to identify and report billing compliance issues and payer discrepancies
• Updates and maintains accurate files on each payer, including contact names, addresses, phone numbers, and other pertinent information; thoroughly documents all interactions with payers
• Utilizes payer scorecards, identifies high-risk accounts, and prioritizes follow-up efforts
• Participates in continuous quality improvement efforts on an ongoing basis, establishing goals with supervisors and tracking progress
• Demonstrates initiative and resourcefulness by making recommendations and communicating trends and issues to management
• Understands and maintains compliance with HIPAA guidelines when handling patient information
• Executes the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party payers in a timely manner
• Tracks the status and progress of denials and appeals
• Conducts relevant research to assist with completing the appeals process and to stay informed on best practices and policy reforms
• Conducts internal and external correspondence accurately, clearly, concisely, and professionally while following organizational regulations
• Works with internal departments and external organizations to resolve appeals
• Maintains data on the types of claims denied and root causes of denials, and collaborates with team members to make recommendations for improvements and resolving issues
• Prepares, maintains, assists with, and submits reports as required
• Regularly makes complex decisions within the scope of the position, and is comfortable working independently
• Collaborates with team members to continually improve services, and engages in process and quality improvement activities
• Demonstrates teamwork and integrity in all work-related activities
• Pinpoints improvement opportunities and contributes to the testing of system modifications; works closely with IT staff and department managers to ensure proper implementation
• Participates in professional development to enhance job knowledge and performance
• Conducts relevant research to assist with completing the appeals process and to stay informed on best practices and policy reforms
• Performs other duties as assigned
  
  

Required Knowledge, Skills And Abilities

• Proficiency in the use of computer software, ability to operate a copier, fax machine, 10 key calculator and printer.
• Excellent verbal and written communication skills in order to effectively interact with patients, customers, employees and Senior Leaders. Must demonstrate the ability to follow verbal and written instructions.
• Attention to detail, with the ability to analyze and determine the type of data needed to complete various types of patient accounting functions.
• Must demonstrate ability to manage time, deadlines, multiple request and priorities, maintain productivity and exercise good judgment with minimal supervision.
• Must have the ability to apply policies and procedures regarding data security and confidentiality to prevent inappropriate release of patient information.
  
  

Minimum Education, Training, And Experience Required

• High School diploma or GED is required.
• Two years of hospital experience in the areas of patient accounts or experience in a physician’s office practice required.
  
  

Reporting Relationship

Reports to Supervisor, PFS