Full time - 36 hours/week or greater First Shift (Days - Less than 12 hours per shift) (United States of America) day shift
Job Information
Exemption Status: Non-Exempt

A Brief Overview
The individual in this role is a key member of the Billing management team responsible for assisting the claim analyst supervisor in supervising day-to-day claim analyst activities. The individual in this role is also responsible for the coordination of the Third Party billing system and the external electronic billing software. The incumbent coordinates the billing functions with a group of employees who perform fairly complex claim submission tasks which are completed to ensure: (1) accurate and timely claim submission to the appropriate third party payers; (2) submitted claims are incompliance with federal/state laws and contractual obligations; (3) maximum customer satisfaction; and (4) maximized cash flow. The incumbent is responsible for training new Billing Representatives, providing continuing education to the billing staff and as a consultant for staff's technical billing questions. The incumbent is also responsible for identifying claims that fail both internal and external billing edits and taking the appropriate action to reduce the number of claims that fail the billing edits. These activities are completed following established policies and procedures, and in compliance with Joint Commission, Medicare, Payer contracts, HIPAA, regulatory agencies and the organization's Code of Conduct.

Education Qualifications

• High School Diploma / GED Required
• Bachelor's Degree Business, accounting, finance or a related field. Preferred

Experience Qualifications

• 2 years Experience in a clinical healthcare setting such as physician's office or hospital relating to patient financial services, patient registration, patient scheduling or related healthcare experience. Required

Skills and Abilities

• Knowledge of major third-party billing and contract requirements. (Required proficiency)
• Working knowledge of basic medical terminology. Understanding of medical/clinical treatment processes. (Required proficiency)
• Keyboarding skill or typing skill of at least 30 wpm. (Required proficiency)
• Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures or government regulations. Superior written and oral communication skills. Ability to effectively present information and respond to questions from management, physicians, employees and the general public. (Required proficiency)
• Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages. Ability to apply concepts of basic Algebra. (Required proficiency)
• Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures or government regulations. Superior written and oral communication skills. Ability to effectively present information and respond. (Required proficiency)

What you will do

• Effectively communicates: (1) third-party payer rules, policies and procedures; (2) internal/external billing software functions to billing staff, education coordinator(s) and other staff involved in the revenue cycle.
• Identifies and notifies management of customer service issues and potential process/system problems that cause billing and payment errors and assists in improvement implementation as requested.
• Identifies and correctly resolves all electronic claim edit failures in a timely manner. Works with clearinghouse as needed for correction and compliance of clearinghouse edits.
• Identifies and correctly resolves claims in a timely manner that were generated with inaccurate information.
• Generates re-bills after all edits have been resolved and re-submits claims to third-party payors.
• Identifies missing or incorrect requirements of rejected claims and either resolves or forwards promptly to appropriate staff for resolution.
• Identifies missing or incorrect requirements of rejected claims and either resolves or forwards promptly to appropriate staff for resolution.
• Completes manual billing process for claims that cannot be sent electronically.
• Effectively functions as liaison between team, other team leaders, PFS management, physicians or other departments within the organization.
• Effectively coordinates team input to department management related to statistical analysis (work performance issues, quality improvement projects, etc.
• Identifies and recommends computer system enhancements, computer applications and procedural changes to improve (1) accuracy and timing of claim submissions; (2) accuracy of third party payer and patient payments; (3) customer relations, and (4) efficiency of operations.
• Ensures the coordination of ongoing staff training and educational development programs with the educational/training staff through staff needs identification and assessment.
• Ensures the practice management software edits are correct and updated in a timely manner.
• Ensures necessary data, identified processing issues and related information is provided to departmental management, appropriate departments and individuals within the organization in a timely manner.
• Reads and comprehends correspondence from government and third-party payers to keep abreast of new regulations, policies and billing and payment requirements.
• Attends internal and external seminars for personal growth and development and shares pertinent information with other team members.

Required for All Jobs

• Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health
• Performs other duties as assigned

Patient Facing Options

• Position is Not Patient Facing

Remote Work Guidelines

• Workspace is a quiet and distraction-free allowing the ability to comply with all security and privacy standards.
• Stable access to electricity and a minimum of 25mb upload and internet speed.
• Dedicate full attention to the job duties and communication with others during working hours.
• Adhere to break and attendance schedules agreed upon with supervisor.
• Abide by Stormont Vail’s Remote Worker Policy and will review and acknowledge the Remote Work Agreement annually.

Remote Work Capability

• Hybrid

Scope

• No Supervisory Responsibility
• No Budget Responsibility No Budget Responsibility

Physical Demands

• Balancing: Rarely less than 1 hour
• Carrying: Rarely less than 1 hour
• Crouching: Occasionally 1-3 Hours
• Eye/Hand/Foot Coordination: Occasionally 1-3 Hours
• Grasping (Fine Motor): Occasionally 1-3 Hours
• Grasping (Gross Hand): Occasionally 1-3 Hours
• Handling: Occasionally 1-3 Hours
• Hearing: Continuously greater than 5 hours
• Kneeling: Occasionally 1-3 Hours
• Lifting: Rarely less than 1 hour up to 10 lbs
• Reaching (Forward): Rarely less than 1 hour up to 10 lbs
• Reaching (Overhead): Rarely less than 1 hour up to 10 lbs
• Repetitive Motions: Continuously greater than 5 hours
• Sitting: Continuously greater than 5 hours
• Standing: Rarely less than 1 hour
• Stooping: Occasionally 1-3 Hours
• Talking: Continuously greater than 5 hours
• Walking: Rarely less than 1 hour

Working Conditions

• Dusts: Rarely less than 1 hour