DHR Health - US:TX:Edinburg - Days
Summary:
POSITION SUMMARY:
This position is responsible for the financial activities of all patient accounts including, but not limited to, all of the following: cashiering, bank deposits and reconciliation, refunds, posting of cash and adjustments, scanning, collections, working AR including denials, review and mailing of patient statements, providing excellent customer service on bills of those patients calling or stopping by the department and provides explanation for any inquiries. The Lead Billing Specialist will act as a resource for other billing specialists and new staff members.
POSITION EDUCATION/ QUALIFICATIONS:
• High School/GED required
• Good written and verbal communication skills required
• Excellent customer service skills required
• Bilingual – English/Spanish – required
• Ability to work with patients in a busy practice
• Computer skills required with knowledge of Microsoft Office suite, Internet, and practice mgmt. software
• Requires reasoning ability, good independent judgment
• Must project a professional image and be able to work with frequent interruptions
JOB KNOWLEDGE/EXPERIENCE:
• Three (3) years’ experience in a physician or hospital business office as a supervisor or significant intra-organizational experience and demonstrated proficiency with existing billing systems and platforms
• Experience working with Excel spreadsheet is required
• Strong knowledge of medical terminology, in house procedures, and overall office procedures
• Excellent interpersonal skills and must be able to be sensitive to cultural and bilingual issues
• Organizational skills are necessary
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 practice
• Outpatient rehabilitation evaluation, re-evaluation and treatment pre-authorization, management and tracking of treatment authorization date frames and applicable CPT codes.
• Prepares office visit, office procedures, hospital procedures, and ancillary procedures and enters into the computer system and reconciles to the system report or scans the charges to the billing vendor as needed
• Monitor scheduling of billing staff to ensure smooth workflow in the clinic on a daily basis, making the best use of provider time when needed for the answering of questions related to billing process
• Monitor patient clinic flow daily, keep billers on task to ensure work is turned in timely to billing company
• Respect and maintain privacy and dignity of patients; assure confidentiality at all times
• Route faxes/scanned documents that come to the fax machine/computer to the appropriate account in the EMR as needed
• Handles calls and questions from patients, physicians, ins. carriers and ancillary providers with questions concerning billing processes
• Ensures that billing daily is completed and sent via electronic batches to billing company and reconciles batches daily
• Posts live commercial, co-pay and other payments as received daily, as needed
• Prepares, double checks, deposit for Office Manager's review and daily deposit
• Balances ERA's with the bank statement as needed
• Works with RMF and hospital revenue cycle personnel with any and all questions regarding billing done in the office
• Ensure all correspondence received is worked daily, including zero payments, denials and other information received from ins. carriers on a daily basis to assist with work administrator duties
• Receives calls/visits from patients and assists staff with questions regarding payments, EOB’s and reasons for denials as requested
• Uses TMHP portal to review patients who are pending Medicaid numbers in order to add those numbers to billings for hospital procedures in order to bill in a timely manner, as needed
• Verifies insurance for any visit/procedure as needed, including pre certification and pre authorizations, as needed
• Ensures that billers are sending day end report to billing vendor, ensuring that all daily tasks are complete and ready for review
• Meet with patients who have balances and need to make payment arrangements, as needed
• Helps with any customer service questions relating to billing or balances owed as needed
• Ensures the timely completion of daily, weekly and monthly reports by billers and preps for Revenue Cycle staff as needed
• Auditing of office visit and procedure charges
• Goes to the bank and/or post office as needed
• Ensure supplies are ordered after inventory is performed
• Works closely with the MOS Lead to ensure the below:
• Referral/pre-authorization/pre-certification requirements have been met in a timely manner
• Verification of the appropriate insurance carrier is assigned to the account and notes changes for reception staff for correction
• Appropriate notes in the patient accounting system by documenting clearly and concisely all patient benefit information
• Prior authorizations for office visits or clinic procedures for patients
• Uses knowledge of procedures to review and coordinate the correct diagnosis with procedures for each patient referral received and the appropriate billing of those visits
• Other duties as assigned.
Other information:
LINES OF REPSONSIBILITES :
(Chain-of-command)
1. Director
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:
· Light/moderate lifting up to 20 lbs, from the floor to shoulder height.
· Must be able to assist other employees with lifting more than 20 lbs.
· Light/moderate carrying up to 20 lbs.
· Reaching above shoulder
· Dual simultaneous grasping
· Depth Perceptions needed
· Operating office equipment
· Operating mechanical equipment
· Ability to read and write
· Ability to hear verbal communication without aid
· Operating Personal Vehicle
· Ability to comprehend written/verbal communication
· Other: Ability to deal with stress
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: ________________________.
