Financial Charges Audit C at PIONEERS MEMORIAL HEALTHCARE DISTRICT – Brawley, California

POSITION SUMMARY: The Financial Charges Audit Clerk is responsible for auditing patient bills (as directed) by comparing to the medical record chart to determine accuracy of charges. Coordinates with all departments regarding findings of audits; this includes hospital-directed audits and third party audit requests.

ESSENTIAL FUNCTIONS:

1. Responds to and calendars all patient bill audits within the hospital utilizing hospital medical records, departmental logs, and qualified medical expertise, hospital-directed audits and/or third party audit requests.
2. Works in cooperation with the HIM Department in order to audit medical record charts to patient billings.
3. Verifies that charges on itemized statements are valid for services rendered and the charges are accurate.
4. Reviews for all undercharges and overcharges on all audits.
5. Inputs into the billing system appropriate credits and debits, balances accounts, and if applicable, requests new bills and forwards them to Billing Services.
6. Processes necessary charge adjustments with third party representatives and serves as hospital liaison with all outside business involved in audits.
7. Provides quality control feedback as it relates to the quality, accuracy, and timeliness of other departments as it relates to the billing process.
8. Keep accurate records on all patients, under scope of responsibility, which includes keeping accurate information on account activity; provides appropriate file documentation as needed to maintain accurate records on status.
9. Demonstrates an understanding of billing and follow-up policies and procedures in performing job duties and instructing patients and hospital personnel. Routinely uses Patient Accounting Policy and Procedure Manual and other reference materials.
10. Responsible for reporting the status of all accounts under scope of responsibility. This includes the timely response to all requests and inquiries by the Department Coordinators or Manager.
11. Performs general clerical functions: answers telephones, types, compiles necessary reports and maintains filing systems for information needed to complete work within the department. Responsible for providing weekly Financial Charges Audit Clerk Report reflecting all activity for the week.

OTHER RESPONSIBILITIES:

1. Utilizes the HIS Affinity System to its full capacity. Continues to grow in the user of the computer system as its capabilities expand.
2. Consistently responds to requests from patients for account charge settlement and related information in a timely and courteous manner.
3. Performs similar job related duties as assigned.

JOB RELATIONSHIPS:

1. Reports directly to the Patient Accounting Coordinator Billing Services.
2. Works closely with Billing Services, Patient Financial Services staff, Compliance, Utilization Review, ancillary departments, HIM, and Information Systems.

EDUCATION, EXPERIENCE, AND SKILLS REQUIRED:

1. High school education or equivalent. Experience of three years of specialized billing and medical background is required.
2. Mathematical ability required to review statistical data on various financial records.
3. 10 key adding machine and typing experience is required. Accuracy is more important than speed. Knowledge of filing systems and copy machines.

AGE OF POPULATION SERVED:

Adolescent, Adult, Geriatrics

PHYSICAL REQUIREMENTS:

1. Sits, stands, bends, lifts, and moves intermittently during working hours.
2. Visual and hearing acuity pertinent to communicating with customers.

MENTAL REQUIREMENTS:

1. Communicative skills necessary to converse effectively with patients and conduct inquires regarding status activity of claims.
2. Ability to work under pressure. Must be able to deal tactfully and effectively with patients and third party representatives.
3. Must possess the ability to make independent decisions when circumstances warrant such action.
4. Is subject to frequent interruptions.
5. Ability to organize and prioritize work to meet deadlines.

SCHEDULING AND AVAILABILITY:

1. Regular hours are Monday to Friday, from 8:00 a.m. to 4:30 p.m. Some flexibility required as determined by the Patient Accounting Coordinators or Manager.
2. This is a full time position requiring attendance at meetings, workshops, and hospital functions as determined by the Patient Accounting Manager.