JOB SUMMARY
Serves as subject matter expert in all billing and revenue cycle activities at TJRH.
JOB REQUIREMENTS
Minimum Education
§ High School Diploma or equivalent is required.
Minimum Work Experience
§ 10 years of revenue cycle coding/billing/collections management
§ In-Depth knowledge of Medicare/Medicaid reporting, billing regulations and compliance
§ Working knowledge of federal, state, local, intermediary and private payor specific billing requirements
§ Working knowledge of all appropriate billing forms, UB04, 1500 or state specified forms, utilizing the electronic billing systems
§ General knowledge of HIM coding, ICD9 & 10
§ Complete understanding of CPT’s and HCPC including modifiers
§ Complete understanding of SSI edits and billing related reports
Required Skills
§ Has advanced knowledge of Microsoft applications including Word, Excel, Outlook and PowerPoint
§ Has an advanced understanding of coding, billing and compliance practices
§ Has expert knowledge of large revenue recognition systems and practice billing systems
§ Possesses expert investigational skills, shows attention to detail, accuracy and ability to manage and prioritize multiple tasks
§ Ability to work independently
§ Possess initiative, analytical skills, and an ability to operate with a high level of productivity
§ Demonstrates advanced communication and presentation skills
§ Ability to work and lead in a team environment and develop constructive working relationships with others
§ Able to lead others through difficult situations.
FUNCTIONAL DEMANDS
Physical Requirements
Sitting – 16 – 31%
Walking - 16 – 31%
Standing - 16 – 31%
Bending/Squatting - 1-15%
Climbing/Kneeling - 1-15%
Twisting - 1-15%
OSHA Category
Minimal Potential for Direct Body Fluid Exposure
Visual and Hearing Requirements
Must be able to see with corrective eyewear.
Must be able to hear clearly with assistance.
Other Physical/Environmental Demands
Lifting - 0-50lbs, 50lbs or more with assistance
Carrying - 0-50lbs, 50lbs or more with assistance
Pulling - up to 100lbs
Pushing - up to 100lbs
LEADERSHIP CAPABILITIES
Supports the hospital Mission, Service and Values.
ESSENTIAL FUNCTIONS
§ Identifying any revenue cycle reimbursement opportunities for improvement within the hospital operations as well as the provider based and RHC clinics
§ Training and educating hospital departments on charge capturing, reconciliation and correction with specific follow up techniques and billing requirements.
§ Informing hospital departments on new regulations from insurance carriers to ensure compliance with proper billing guidelines necessary for reimbursement
§ Working the unbilled report with necessary departments to reduce unbilled days
§ Identifying and resolving any charging issues (improper charges and/or missing charges) as well as charging issues outside workflow process. Escalating the issues to management when necessary
§ Ensuring appropriate prior treatment authorizations are completed and/or notifies appropriate person of missing or incomplete billing requirements and follows up in a timely manner
§ Researching for proper charging for billing requirement to ensure submission of clean and compliant claims to governmental and private payers
§ Identifying and resolving core issues causing delayed payments, under payments, claim denials and zero pays
§ Periodically auditing bills and comparing to medical records and clinical documentations to support claims or appeals as necessary
§ Working on financial or compliance audits as necessary
§ Working with Business Office Leadership to improve the AR, Cash Flow and other key indicators.
