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Insurance Billing Representative
Department: SBS - Billing & Claims
Schedule: Full-Time
Shift: Day
Hours:
Job Details:

Monday-Friday, day shift hours, full-time position will work 40 hours per week. 

Purpose: Responsible for accurate and timely submission of billing information to multiple payors, such as Medicare, Medicaid, Blue Cross, commercial, and PPO/HMO for Health System in multiple states.  Must have comprehensive understanding of federal and state regulatory guidelines for primary and secondary claims.  Must be accountable for maintaining accurate insurance information for both Cerner and Meditech systems.  Conducts review of the patient's account for discrepancies of charges and communicates with various departments and insurance payors for verification of detail.  Must demonstrate high level of knowledge of CPT, HCPC, modifiers, and current versions of diagnosis coding as well as 837P and 832P electronic submissions.  Must demonstrate knowledge of multiple software systems such as CCSM, SSI, HPF, TRAC, C-SNAP, and CareMedic. Must have ability to adapt to frequent regulatory billing changes and complete billing requirements utilizing payor websites. Will assist in one on one process training of new staff.

Report To: Supervisor, Billing

Supervisory Responsibility: No Supervision: The job does not require the provision of guidance or supervision to others.  There is no formal responsibility for directing others.

Materials Responsibility: Very Limited. Work requires very limited responsibility for material resources.  Examples of resources could include personal work materials, supplies or equipment, or very small amounts of cash. The employee has a very limited or indirect amount of control over these resources. Although human error might require the repair or replacement of materials, usually the cost of correcting these errors is minor.  The variety and volume of resources is also very limited.  Problems associated with material resources are very uncomplicated.

Key Relationship: Co-workers/Health System Employees, Outside Agencies/Other Health Care Providers, Governing Boards, General Public/Visitors/Volunteers, Physicians/Medical Office Staff, Students/Interns/Residents/Outside Instructors, Patients, Families, and Significant Others, Vendors/Clients, Third Party Payors/Insurance Companies, Local Governments, News Media, Attorneys.

POSITION SPECIFICATION

Education: High school graduation or equivalent

Special Training: Interpretation of insurance EOBs, concurrent multiple software systems usage.

Training Preferred: Billing/Accounts Receivable experience (UB04, 1505, 837I, 837P), Medicare and Medicaid compliance; Quality Improvement; CPAT, CHAT

Experience: More than 1 year experience required.

Interpersonal Skills: Interaction is with a variety of people. These may be fellow employees, customers, the public or others outside the organization. Communications are of limited difficulty. Interactions usually involve short, straightforward exchanges of information. The job requires a limited amount of interpersonal skills. Interactions are non-stressful encounters and dealing with uncomplicated problem situations.

Physical Demands: Low Intensity: Work requires a light or low amount of physical exertion. The job requirements for manual dexterity or physical manipulation are limited.  The need for physical stamina and endurance is of minimal or low significance.  The degree of physical strain produced on the job is somewhat taxing, but does not usually produce fatigue and require periods of rest.  Freedom of movement exists, and the job does not confine the employee to a prescribed body posture.  Body movement usually involves sitting and intermittent walking.  The position exceeds these low intensity demands rarely, 10% of the time or less.

Working Conditions: There are little or no adverse environmental conditions to consider.

Possible Exposure to Blood Borne Pathogens: None

   
     

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