Specialty Biller (Full Time) - Patient Financial Services

Key Responsibilities

• Provides excellent customer service and adheres to the Behavioral Expectations Agreement and the mission, vision, and values of KHI.
• Affixes assistance 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.

Accuracy

• 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.
• Mets established accuracy metrics as communicated by management.

Timeliness

• Understands contracts and payer specific guidelines in order to ensure timely follow up to 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, e-mail, and task inquiries.

Productivity

• Mets productivity standards for sending out bills daily, working billing reports, and correcting rejections efficiently.
• Mets productivity standards for working outstanding accounts and denials in an effort to achieve claim resolution.
• Mets established productivity expectations as communicated.

Qualifications

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

Preferences

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