Job Purpose & Position Overview

This position is located in the Business Office of the 12 Clans Unity Hospital. The purpose of this position is to abstract and interpret data from records in preparation and submission of third party claims. The employee provides billing services, which is the key point for interaction with patients to obtain and process demographic and insurance information for alternate resources and other pertinent health information.

Specific Job Duties/Responsibilities:

• Analyze and maintain a portion of the total billing operation for third party resources, and act as an advocate for 12 Clans Unity Hospital in the collection of alternate resources. Initiates all third party billing, research and retrieve individual patient health record(s) to gather and compile information for outpatient and inpatient medical services. Review claim forms for accuracy, which includes the billing and coding information on the claim prior to submission.
• Responds to third party requirements for post-payment reviews, exclusions, denials, and appeals.
• Verifies that medical records contain proper documentation in accordance with regulations, physician/physician assistant original signature(s), accurate dates of medical care services are in compliance with attestation and billing requirements.
• Maintains files regarding the third party program, which includes letters and other materials for state, federal, and other agency review. Maintains Medicare/Medicaid, and Private commercial insurance manuals and directives.
• Answers telephone and personal inquiries regarding claims, collections, etc. Answers technical correspondence and compiles information for reporting.
• Performs other duties as assigned.

Required Qualifications/Skills:

• A thorough knowledge of Medicare/Medicaid and Third Party guidelines and regulations necessary to ensure that the prescribed procedures are properly applied. Individual will be able to analyze problems and make decisions regarding the adequacy of the content of the billing form to ascertain whether billing is appropriate.
• Knowledge of the substantive programs of 12 Clans Unity Hospital as they relate to the Medicare/Medicaid and Third Party functions and skill to coordinate job duties with others.
• Knowledge of the 12 Clans Unity Hospital Third Party Billing programs/software and competent ability to utilize a personal computer, keyboard, etc. Knowledge and application of ICD-10 CM coding procedures, abbreviations, terms, etc. and current knowledge and application of CPT codes based on current and standardized billing practices.
• Knowledge of the Privacy Act of 1974, and use of confidential information.

Training Requirements:

• High School Diploma/G.E.D is required
• Strong organizational and multi-tasking skills
• Proven ability to handle confidential information with discretion, be adaptable to various competing demands, and demonstrate the highest level of customer/client service and response

Physical Requirements:

• Normal to light office work which includes the ability to lift up to 10 lbs.
• Regularly required to walk, stand, and sit for extended periods of time and use hands to operate computer keyboard, phone, and various office equipment.
• While performing daily duties, the employee is regularly required to talk and hear.

Cognitive Requirements:

• Reading, writing, calculating
• Above average social interaction skills

• Reasoning/Analysis
• Works with minimal to no supervision

Language Requirements:

• Must possess the ability to read, write, and speak the English language fluently.
• Must be able to continually and effectively employ professional verbal and written communications skills.

Certificates, Licenses & Registrations:

• All applicants will comply with 45 CFR 1301, Subpart D, Section 1301.31, C and D, which require all prospective employees to sign a declaration prior to employment regarding all arrests and convictions of child abuse or violent felonies and to comply with PL 101-630 and PL 101-637 regarding criminal records check.