GENERAL DESCRIPTION OF POSITION
The main purpose of this position is to provide customer service in the billing department. This includes, but is not limited to, billing, collections, data entry of medical records, customer relations with area medical facilities, customer relations with patients, and coordination with dispatch and field staff.
ESSENTIAL DUTIES AND RESPONSIBILITIES
1. Accounts receivables. (Collecting payments in the form of cash, check, electronic fund transfers, and credit card payments from private pay accounts as well as from insurance companies. Ensuring proper posting of these payments in either of the two software programs. Calculating daily deposits and running reports in the software to ensure the amounts posted match the amount of money that came in for the day. Spot auditing all accounts while entering daily payments to ensure any mistakes are caught at that time). This duty is performed daily, about 20% of the time.
2. Follow-up on claims to ensure proper payment. (Contacting insurance companies to follow-up on claims, correcting any necessary information, following up on denials from insurance companies, filing appeals and reconsiderations to insurances on behalf of our patients). This duty is performed daily, about 20% of the time.
3. Accept responsibility and accountability for billing customers and insurance companies (coding the medical claims with proper information for submission, ensuring correct patient demographic information and insurance information for billing purposes, researching and correcting any accounts that we received returned mail from. Handle organizational filing, restocking and resupplying). This duty is performed daily, about 20% of the time.
4. Accurately filing insurance claims for commercial insurances, automobile accident claims, Workman's Compensation, and Medicare/Medicaid (including both electronic submissions and paper claims). Printing and attaching any necessary information to claims that require additional information to process: ie: medical records, primary explanation of benefits, etc. Keeping updated on all new laws, rules and regulations concerning Medicare, Medicaid, Workman's Compensation, and auto insurance). This duty is performed daily, about 20% of the time.
5. Researching liability claims; i.e., Workman's compensation, automobile accidents, third party claims. Contacting local police departments to obtain records of events. Filing appropriate claims, following up with liens if necessary to ensure direct payment). This duty is performed daily, about 10% of the time.
6. Organizing long distance transfers. Providing cost estimates to area facilities, contacting insurance companies if necessary to verify coverage and benefits, and determining if insurance coverage will extend to our patient. This duty is performed weekly, about 5% of the time.
7. Search membership program to identify members when processing accounts receivables. This duty is performed daily, about 5% of the time.
8. Perform any other related duties as required or assigned.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty mentioned satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.
EDUCATION AND EXPERIENCE
High school or GED, plus specialized schooling and/or on the job education in a specific skill area; e.g. data processing, clerical/administrative, equipment operation, etc, plus 7 to 11 months related experience and/or training. Or equivalent combination of education and experience.
COMMUNICATION SKILLS
Ability to read, analyze, and understand general business/company related articles and professional journals; Ability to speak effectively before groups of customers or employees.
MATHEMATICAL SKILLS
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to prepare and interpret bar graphs.
CRITICAL THINKING SKILLS
Ability to utilize common sense understanding in order to carry out written, oral or diagrammed instructions. Ability to deal with problems involving several known variables in situations of a routine nature.
REQUIRED CERTIFICATES, LICENSES, REGISTRATIONS
Not indicated.
PREFERRED CERTIFICATES, LICENSES, REGISTRATIONS
Not indicated.
SOFTWARE SKILLS REQUIRED
Advanced: Other, Word Processing/Typing
Intermediate: 10-Key, Alphanumeric Data Entry
INITIATIVE AND INGENUITY
SUPERVISION RECEIVED
Under direction where a definite objective is set up and the employee plans and arranges own work, referring only unusual cases to supervisor.
PLANNING
Considerable responsibility with regard to general assignments in planning time, method, manner, and/or sequence of performance of own work, in addition, the work operations of a group of employees, all performing basically the same type of work.
DECISION MAKING
Performs work operations which permit frequent opportunity for decision-making of minor importance and which would not only affect the operating efficiency of the individual involved, but would also affect the work operations of other employees and/or clientele to a slight degree.
MENTAL DEMAND
Moderate mental demand. Operations requiring almost continuous attention, but work is sufficiently repetitive that a habit cycle is formed; operations requiring intermittent directed thinking to determine or select materials, equipment or operations where variable sequences may be selected by the employee.
ANALYTICAL ABILITY / PROBLEM SOLVING
Moderately repetitive. Activities with slight variation using a definite set of processes or directions with some degree of supervision. Choice of learned things in situations which conform to clearly established patterns and modes.
RESPONSIBILITY FOR WORK OF OTHERS
The level of direct supervisory responsibility for the assignment of job duties, training, leadership, guidance, needs of employees, hiring, terminating and/or direction of the effort of others. Scoring will depend upon the number and classification of people normally supervised or directed, and the scope of complexity of the operations involved in the supervisory responsibility. (Job classification which involves no supervision will not be assigned a point value for this factor.)
No supervision.
Supervises the following departments:
RESPONSIBILITY FOR FUNDS, PROPERTY and EQUIPMENT
Occasionally responsible for organization's property where carelessness, error, or misappropriation would result in moderate damage or moderate monetary loss to the organization. The total value for the above would range from $5,000 to $150,000.
ACCURACY
Probable errors of internal and external scope would have a moderate effect on the operational efficiency of the organizational component concerned. Errors might possibly go undetected for a considerable period of time, thereby creating an inaccurate picture of an existing situation. Could cause further errors, losses, or embarrassment to the organization. The possibility for error is always present due to requirements of the job.
ACCOUNTABILITY
FREEDOM TO ACT
Directed. Freedom to complete duties as defined by wide-ranging policies and precedents with mid to upper-level managerial oversight.
ANNUAL MONETARY IMPACT
The amount of annual dollars generated based on the job's essential duties / responsibilities. Examples would include direct dollar generation, departmental budget, proper handling of organization funds, expense control, savings from new techniques or reduction in manpower.
None. Job does not create any dollar monetary impact for the organization.
IMPACT ON END RESULTS
Moderate impact. Job has a definite impact on the organization's end results. Participates with others in taking action for a department and/or total organization.
PUBLIC CONTACT
Regular contacts with patrons, either within the office or in the field. May also involve occasional self-initiated contacts to patrons. Lack of tact and judgment may result in a limited type of problem for the organization.
EMPLOYEE CONTACT
Contacts with other departments or offices and also frequently with individuals in middle level positions; consulting on problems which necessitate judgment and tact in presentation to obtain cooperation or approval of action to be taken. Also, important contacts with associates as required in advanced supervisory jobs.
USE OF MACHINES, EQUIPMENT AND/OR COMPUTERS
Regular use of complex machines and equipment (desktop/laptop computer and software, road and production machines and equipment, driver's license/cdl, etc.)
WORKING CONDITIONS
Periodically exposed to such elements as noise, intermittent standing, walking, occasionally pushing, carrying, or lifting; but none are present to the extent of being disagreeable.
ENVIRONMENTAL CONDITIONS
The following work environment characteristics described here are representative of those an employee encounters while performing essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate.
PHYSICAL ACTIVITIES
The following physical activities described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions and expectations.
Highly repetitive, low physical. Highly repetitive type of work which requires concentration in the performance of tasks for consistent time cycles as prescribed by the tasks.
While performing the functions of this job, the employee is continuously required to sit, talk or hear; occasionally required to stand, walk, reach with hands and arms, stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision.
ADDITIONAL INFORMATION
Not indicated.
