Job Summary:

To ensure prompt and efficient billing and follow up of all claims in order to receive payment in a timely manner. Is a “working supervisor,” and is willing and able to perform any duty in the billing/follow-up area as the need arises. In performance of these duties, this role is responsible for and includes, but is not limited to, the following:

• Responsible for processing billed error and hold claims on a daily basis. Ensures that the hold claims are at an acceptable level. Communicates with the appropriate departments to ensure data is obtained timely in order to file the claim.
• Ensures there is no excessive and/or unjustified amount of backlogged claims in the work area. Maintains a clear understanding of goals set and strives to meet these goals weekly.
• Able to perform manual intervention of claims such as “split bill”, add room charges, or any other procedure necessary to process an account.
• Responsible for filing all claims requiring special documentation. Each claim must be reviewed and submitted/mailed on a daily basis.
• Average quantity and value of accounts worked each day meets standards. Working an account includes filing, rebilling, appealing and working of insurance claims on the hospital accounts receivables.
• Updates to patient accounts notes are documented with appropriate detail. Adjustment requests are accurately computed and documented.
• Patient accounts' tools are being utilized to enhance and expedite collections.
• Work queues used with appropriate work-again dates, billing activities codes, sorts, etc. Carrier websites are utilized, as well as Medicare DDE.
• Patient account notes reflect the aggressive collection logic necessary for expediting payments.
• Ensures that all staff complete their assigned duties effectively and accurately.
• Effectively handles problems brought up by staff by identifying and finding a solution to the problem.
• Performs all duties expected of a supervisor, including monitoring of staff time and attendance, staff work schedules, mentoring and training, disciplinary conferences, and overall team leadership.
• Reports all issues or concerns regarding the insurance billing area to the appropriate manager. Keeps manager informed and up to date on issues pertaining to the billing area.
• All other duties assigned
• Must be able to demonstrate knowledge and skills to appropriately communicate and interact with the patients, families, and visitors of all age groups while being sensitive to their cultural and religious beliefs.

Performance Expectations:

• Maintains aged A/R inventory greater than 90 days from bill date at 35% or lower of total A/R
• Achieves monthly Cash Goal established by management and Administration 60% of the time
• Ensures initial primary claims presented in Epic that are clean are transmitted through SSI within 24 hours
• Maintains work queues at a level that ensures no accounts are unworked for 15 business days after presenting to the work queue
• Audits staff accounts worked monthly to ensure full, accurate, timely and appropriate notation in Epic
• Maintains Kronos time records and approvals by the set deadline dates/times
• Ensures all HealthSpring educational requirements of staff are completed by due dates 100% of the time
• Ensures employee computer and other system issues are corrected within 24 hours

Qualifications:

Education/Skills:

Some college is preferred. High school diploma or equivalent is required.

Work Experience:

Three years of experience as an insurance biller, preferably in a hospital business office. Extensive knowledge of Medicare, Medicaid, and insurance is preferred. One year of supervisory experience is preferred.

Mental Demands:

Oral and written communication skills are important to relate to hospital personnel, patients, and other third parties. Must have basic math skills to perform calculations for insurance analysis and proration. Typing skills preferred. Microsoft Excel experience is required.

Work Location:

This position offers both in-office work and telecommuting work from home. Ample workspace will be provided by Forrest General Hospital (FGH) for office work. Appropriate telecommuting work environment includes, but is not limited to:

• High speed internet service provided by the employee
• Desktop space to accommodate a laptop, two (2) monitors, keyboard, mouse and paper
• Private area/room without interruption

Acknowledgment of FGH-issued equipment that remains the property of FGH and shall be returned undamaged in the event employment is terminated.