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DepartmentCS Patient Financial Services
Scheduled Weekly Hours40
Job SummaryProvide an escalated level of claim processing to ensure the proper interpretation, processing, recording, approval and payment of inpatient and outpatient medical claims. Accurately reviews information for processing claims into a computerized system in accordance with the primary payer specifications and billing guidelines. Resolves more complex billing issues and provides training and mentoring to those in a Biller I role.
- Demonstrates application of compliance standards and payer specific data to properly file claims and ensures prompt, appropriate reimbursement of services and supplies billed to third parties and appropriate payment of services and supplies due from patients, as evidenced by documentation, observation and feedback.
- Proficient in third party payer procedures including, but not limited to: Blue Cross, Medicare, Medicaid, Indian Health Services, TriCare, and all other third party contractual agreements as required. May be asked to demonstrate specific knowledge for more complex billing models, such as, but not limited to: rural health and dialysis.
- Knowledgeable in split claim processes, specific to governmental payers.
- Demonstrated knowledge of 24/72 hour overlap rules in move charges and prevent denials.
- Thorough understanding of the Medicare portal in order to adjust and void claims and verify eligibility.
- Partner with internal caregivers to resolves complex billing issues for the self-pay and customer service teams.
- Monitor department metrics to draw conclusions regarding claims submission issues that might require Compliance and Charge Master staff to resolve, or HIPAA transaction code set review. Research payer requirements and offer suggestions to leadership for claims submission issues.
- Manages and reconciles daily claim runs between EPIC and clearinghouse as needed.
- Proficient in working denial follow up and first level appeals.
- Provide training and mentorship to other caregivers.
- All other duties as assigned.
Education - High School Diploma/GED Equivalent in General Studies
Certifications - Certified Revenue Cycle Specialist Professional (CRCSP) - American Association of Healthcare Administrative Management (AAHAM)
Experience - 1+ years of Clerical Experience; 1+ years of Medical Patient Accounts/Financial Services ExperienceSedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.15 Corporate Services Division
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Monument Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.Apply