What are the responsibilities and job description for the Insurance Claim Biller position at Humboldt General Hospital?
JOB DESCRIPTION
JOB CODE:
JOB TITLE: Insurance Claim Biller
DEPT #: 7700
DEPT NAME: Business Office
FLSA STATUS: o EXEMPT o NON-EXEMPT
REPORTS TO: Collection Supervisor
DATE CREATED:
DATE REVISED:
POSITION SUMMARY
(General statement reflecting the overall purpose of the position)
Humboldt General Hospital is looking for an experienced Insurance Claim Biller familiar with claim submissions to insurance companies and experience working with SSI. This candidate will be responsible for submitting correct or self-corrected claims, working patients encounters via established work queues and communicating and coordinating with revenue cycle colleagues. Attention to detail and superior customer service skills is necessary.
POSITION QUALIFICATIONS
MINIMUM EDUCATION: High School diploma or General Education Degree
PREFERRED EDUCATION:
MINIMUM EXPERIENCE: Basic knowledge of third-party insurance plans billing.
REQUIRED CERTIFICATIONS:
PREFERRED CERTIFICATIONS/LICENSES: CRCR
SPECIAL SKILLS: Cerner Community Works/Revenue Cycle and SSI experience is preferred. Excellent command of written and spoken English; must be able to communicate effectively when in contact with insurance carriers, third-party payers and patients. Must be able to learn and understand patient accounting policies and procedures and how the EHR computer system works. Intermediate knowledge of Microsoft Word and Excel and the ability to learn new programs and systems is necessary. Dependable in both productivity and attendance.
SUPERVISES: None
PHYSICIAL DEMANDS: For physical demands and working conditions, see next page.
TASK LETTER CODE
PRIMARY DUTIES
(Are the essential job tasks or primary responsibilities that the individual who holds the position mist be able to perform unaided or with the assistance of an accommodation. For example: DO (action verb) WHAT (object) Collects vitals from patients at the being of the visit according to clinic protocol.
% OF TIME PERFORMING DUTY
A
Submit correct clean claim to payors, or submit correction, of UB and/or 1500 claims forms. Review and process claims in various stages of revenue cycle in a timely manner.
B
Resolve encounters assigned via work queues and apply action when appropriate
C
Review claim edits from front and back-end scrubbers to reduce denials
D
Review edits received from SSI, correct claim and regenerate as appropriate.
E
Receives and takes calls from patients with insurance information updates such as COB
F
Receive, and take, Inbound and outbound calls with government payors and commercial insurance payors
G
Prepare and fille insurance appeals timely
H
Work AR as assigned.
I
Modify charge grouping and registration when necessary for proper claim submission
J
Manage SSI web portal to include generating reports, working timely filing claims and troubleshooting claim submissions. Identify and log trending claim denials.
K
Maintains confidentiality adheres to all HIPAA guidelines/regulations
L
Other related duties as assigned.
M
N
O
DESCRIPTION OF ESSENTIAL PHYSICAL DEMANDS AND WORKING CONDITIONS
JOB TITLE:
Physical Requirements/Conditions:
- Ability to walk, stand, stoop, bend or sit for extended periods of time
- Physical demands: Walking 20% - delivering information to other departments
- Sitting 80% - entering data into computer system; answering the telephone
- Ability to speak clearly to be understood by employees and patients
- Works in well-lit heated/air-conditioned environment
- Considerable reaching, stooping, bending, kneeling, crouching
- Visual acuity with or without correction
- Acute sense of hearing with or without correction
- Work my involve exposure to communicable diseases medicinal preparations and other conditions common to hospital environment
Required Protective Equipment:
- Masks and eye protection may be required
Review:
I have read and understand the job description for the position of Claims Follow-up Representative Acute and Ambulatory. The expectations of my job have been explained to me and I have had an opportunity to ask questions. I acknowledge that the contents of this job description are intended to describe the general nature and level of work being performed by person assigned to this position and are not to be construed as an exhaustive list of all responsibilities, duties, and skills of the person so classified. Further, I certify that I can meet the personal/physical/licensure/certification requirements of this position.
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Employee Name (Print) Employee Signature Date
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Leader Name (Print) Leader Signature Date
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HR Representative Name (Print) HR Representative Signature Date