PFS Specialty Biller-8115

All KHI employees are expected to perform their respective tasks and duties in a manner that supports KHI’s vision of providing the region’s best clinical care and patient service through an environment that fosters respect for others and pride in performance.

Responsibilities

• Provides excellent customer service and adheres to the Behavioral Expectations Agreement and the mission, vision, and values of KHI.
• Assists in process improvement to bring about greater billing efficiency and accuracy.
• Participates in business division meetings, performance improvement activities, and committees as assigned.
• Communicates issues with incorrect or unclear information within training materials.
• Utilizes Issues Log or other requested means of communication regarding issues, when necessary.
• Performs other job duties, as assigned, to help meet the team’s goals and objectives.
• Reviews UB04s, CMS 1500s, and/or itemized statements for completeness, efficiency, and accuracy.
• Reviews claims for reasonableness of charges and obtains supporting medical documentation for claims when necessary.
• Contacts employers, payers, and/or patients for updated claim information.
• Bills clean claims for Acute and Ambulatory Medicare, Home Health, Hospice, Corporate, Indian Health, and/or Liability services.
• Bills secondary insurance, when appropriate.
• Works rejection reports, including correction of demographic information, to ensure appropriate billing.
• Works rejection reports to re-bill claims accurately.
• Appropriately works the accounts receivable and denials.
• Adheres to policies and procedures to achieve departmental and hospital goals.
• Reviews training materials periodically to ensure accuracy and compliance with updated billing procedures.
• Uses Direct Data Entry (DDE) to resolve billing issues for Medicare claims.
• Meets established accuracy metrics as communicated by management (metrics may differ depending on biller level).
• Understands contracts and payer-specific guidelines to ensure timely follow-up and avoid untimely denials and delays in cash flow.
• Maintains and facilitates communication within the business and clinical divisions.
• Completes timely follow-up on accounts, resolved denials, and/or other correspondence.
• Responds professionally and within appropriate time frames to telephone, email, and task inquiries.
• Meets productivity standards for sending out bills daily, working billing reports, and correcting rejections efficiently.
• Meets productivity standards for working outstanding accounts and denials to achieve claim resolution.
• Meets established productivity expectations as communicated (metrics may differ depending on biller level).

Requirements

• High school graduate or equivalent required.
• One (1) year of medical billing and/or collections experience required.

Skills

• Demonstrates ability to communicate effectively with all types of customers, manage multiple priorities and tasks, and maintain attention to detail.
• Demonstrates knowledge of and ability to use computer hardware and software applications.
• Demonstrates improving proficiency in billing by meeting required departmental standards (measured by formal and informal audits).

Preferences

• Working knowledge of Medicare billing practices in a Hospital, Physician Clinic System, Home Health, and/or Hospice Setting.

Special Position Requirements

• Exposure category: II.
• Other potential hazards: possible exposure to chemical substances; possible exposure to hostile individuals.
• Employee must be capable of consistently reaching and/or working above and below shoulder level; sitting at a computer terminal 90% of the time per day; walking or on feet 10% of the time per day with frequent bending, squatting, kneeling, standing; communicating using a telephone.
• Must be able to deal calmly and effectively with frustrated and/or angry clients.