This position is responsible to accurately correct and verify all demographics and payer information provided by interface encounters by removing all claim holds within laboratory billing application and also all edits produced by claims at the clearinghouse in an effort to submit clean claims to Medicare, Medicaid, managed care and commercial insurance payers within timely filing guidelines as determined by hospital contracts and payer requirement. POSITION EDUCATION/ QUALIFICATIONS :
High School Diploma/GED is required
Medical coding and billing certificate preferred
Basic computer skills are required
Typing skills of 35 wpm
Knowledge of basic Microsoft programs word and excel
Good written and verbal communication skill required JOB KNOWLEDGE/EXPERIENCE :
One (1) year of billing experience in medical office or hospital setting required
Two (2) years hospital billing preferred
Must have working knowledge billing claims using a clearinghouse
Must have working knowledge of medical Terminology: CPT Codes. modifiers and diagnosis codes as they relate to billing
Specific knowledge of Texas Medicare, Medicaid, Managed Care, and Commercial Health Insurances rules and regulations as they pertain to billing
Ability to research, analyze and resolve claim edits with third party payers for proper submission of claims
Strong time management, organizational skills and attention to detail is essential. Passion for excellence, commitment to customer satisfaction, patient and friendly attitude

POSITION RESPONSIBILITES:
Responsible for the correction of all claim edits identified by clearinghouse for each payer
Verifies completeness and accuracy of all claims prior to submission of claims
Must research properly coding issues, diagnosis issues, and demographic issues by looking at provider billing manuals, calling insurance payers, and checking eligibility and benefits as needed.
Responsible for working all EDI claim rejected payer reports and resubmitting those claims
Must be able to work closely with provider clinic offices and staff to obtain missing information required by specific payer to successfully submit insurance claims to payer
Staff Assigned to pre-billing edits will work all unbilled claim holds including but not limited to accounts missing diagnosis, missing payer information, missing demographic, failed NCD and duplicate account match failures
Verification of all failed demographic and insurance information is to be done timely via payer websites or by calling customer service centers, patients or referring provider office as needed for corrections
Responsible for correctly adding modifiers for received ABN’s from various locations and entering this information appropriately for billing purposes
Pre-billing staff may be assigned to various system generated work error queues and must prioritize these to minimize any financial loss to facility and within timely filing deadlines for payers.
Handles incoming calls and inquires routing appropriately; taking over the phone payment transactions, or assisting in resolving concerns dealing with accounts
Work return mail, make corrections in system and re-send statement as needed
Must meet minimum productivity standards as determined by management Other duties as assigned Other information: LINES OF REPSONSIBILITES : (Chain-of-command) 1. Business office manager → 2. Outreach Laboratory Billing Director → 3. Administrator CUSTOMER SERVICE: Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including: Commitment, Accountability, Respect, Excellence and Service. AGE SPECIFIC : Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret the appropriate information needed to identify each patient’s requirement relative to his or her age. AMERICANS WITH DISABILITIES ACT: (ADA) : A.

Indicated by bold print within performance standards, preceding individual numbered criteria. The following table provides physical requirements that will be associated with, but not limited to, this position:
Light/moderate lifting up to 20 lbs, from the floor to shoulder height.
Yes
Kneeling
Yes
Must be able to assist other employees with lifting more than 20 lbs.
Yes
Walking
Yes
Light/moderate carrying up to 20 lbs.
Yes
Standing/Squatting
Yes
Straight pulling
Yes
Sitting
Yes
Pulling hand over hand
Yes
Pushing
Yes
Repeated bending
Yes
Stooping/Bending
Yes
Reaching above shoulder
Yes
Climbing Stairs
Yes
Simple grasping
Yes
Climbing Ladders
No
Dual simultaneous grasping
Yes
Depth Perceptions needed
Yes
Ability to see
Yes
Identify Colors
Yes
Operating office equipment
Yes
Twisting
Yes
Operating mechanical equipment
Yes
Crawling
No
Ability to read and write
Yes
Ability to Count
Yes
Ability to hear verbal communication without aid
Yes
Operating Personal Vehicle
Yes
Ability to comprehend written/verbal communication
Yes
Other: Ability to deal with stress
Yes
OSHA Category
III
B. Working Conditions : The individual spends over 95% of his/her time in an air-conditioned environment with varying exposures to noise. There is protection from weather conditions but not necessarily from temperature changes. The position does have low exposure to malodorous, infectious body fluids from patients and some minimal exposure to noxious smells from cleansing agents. C. Occupational Exposure: This position has minimal to no exposure to blood, body fluids, or tissues and is an OSHA Category III (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Person who performs these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid or to be potentially exposed in some other way. D. Aptitudes : HIGH 1 2 3 4 5 6 LOW Intelligence: General learning ability: The ability to “catch on” or understand instructions and underlying principles. Ability to reason and make judgments. 3 Verbal: Ability to understand meanings of words and ideas associated with them, and to use them effectively. To comprehend language, to understand relationships between words, and to understand meanings of whole sentences and paragraphs. To present information or ideas clearly. 3 Numerical: Ability to perform arithmetic operations quickly and accurately. 2 Spatial: Ability to comprehend forms in space and understands relationships of plane and solid objects. Frequently described as the ability to “visualize” objects or two or three dimensions, or to think visually of geometric forms. 2 Form Perception: Ability to perceive pertinent details and objects or in pictorial or graphic material to make visual comparisons and discriminations and see slight differences in shapes and shadings of figures and widths and lengths of lines. 3 Clerical Perception: Ability to receive pertinent details and verbal or tabular material. To observe differences in copy, to proofread words and numbers, and to avoid perceptual errors in arithmetic computation. 2 Motor Coordination: Ability to coordinate eyes and hands to fingers rapidly and accurately in making precise movements with speed. Ability to make a movement response accurately and quickly. 3 Finger Dexterity: Ability to move hands easily and skillfully. To work with fingers in placing and turning motions. 3 Manual Dexterity: Ability to move hands easily and skillfully. To work with hands in placing and turning motions. 3 Eye-Hand-Foot Coordination: Ability to move the hand and foot coordinately with each other in accordance with visual stimuli. 3 Color Discrimination: Ability to perceive and respond to similarities or differences in colors, shapes, or other values of the same or different color. To identify a particular color, or to recognize harmonious or contrasting color combinations, or to match color adequately. 3 I have read and reviewed my job description with my supervisor or designee and I understand the job I am expected to perform. If applicable ____________ certification will be completed within _________ time frame of hire/transfer date. Employee Signature: ________________________________ Date: ____________________ Transfer/Hire Date Effective: ________________________.

Billing Specialist,-FT-Days- Outreach Lab

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