Handles the complete processing of patient accounts with third party carriers from start to finish to include but not limited to: billing the claim either electronically or paper, supplying additional information necessary for claim adjudication, and answering patient and insurance company questions. Major Job FunctionsThe following is a summary of the major essential functions of this job. The incumbent may perform other duties, both major and minor, that are not mentioned below.
In addition, specific functions may change from time to time:Submits primary insurance claims to all carriers using the electronic claims terminal or send hard copy claimsUses the on-line work list and account referrals to review accounts that are pending payment from insurance companies for additional informationValidates the accuracy of patient information so that future billing and follow-up activities are conducted effectively and to ensure a high degree of customer service.
Applies adjustments and write-offs to accounts according to policy and procedure to assure accurate account balances and statementsMaintains a suspense file of accounts that need additional documentation for eligibility determination prior to billingReceives incoming calls from patients and/or insurance companies concerning open accounts and answers questions and provides information in a courteous and cooperative manner to maintain good customer relationsOther duties as assignedMinimum QualificationsThe following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this job:Education and Formal Training: High school diploma or equivalent requiredWork
2 years’ experience with electronic hospital billing or collections in a medical field required1 year of experience with personal computer software and other office equipment required1 year of medical terminology and familiarity with CPT-codes, ICD-10 codes and HCPCS codes preferredKnowledge, Skills, and Abilities Required: Proficiency in reading, writing, and speaking the English languageKnowledgeable in third party claim adjudication to include: Medicare, Medicaid, Tricare, commercial insurance, and managed careMust pass departmental training (calculating reimbursement, UB-04, Patient Account Terms and System Navigation) tests 75% or higherExcellent verbal and written communication skillsAnalytical ability and accurate mathematical calculation skillsPhysical
Near visual acuity requiredMotor coordination and finger dexterity required to complete repetitive functions with computer and other office equipmentAbility to lift twenty-five poundsAbility to talk and to receive information by telephone is requiredRequired Licenses and CertificationsCape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity