The Billing Coordinator is responsible for performing all billing and collection - related duties on patient accounts. Performs a variety of Medical Records duties such as chart analysis, abstracting, audits, and coding. Prepares and responds to correspondence and records for the release of patient information. This position is expected to be knowledgeable of the specific provisions in the managed care contracts as they relate to billing/reimbursement. Individual shall be knowledgeable of the most current coding policy and patient confidentiality requirements. Individual shall be flexible to perform a variety of duties. This position requires strong interpersonal skills to regularly interact professionally, promptly, and courteously with patients, physicians, and their offices and other Center personnel to maintain strong public and community relations while responding to their inquiries/requests. May be assigned additional delegated responsibilities and special assignments by the Business Office Manager.
Reporting Relationship:Reports to Business Office Manager.
Essential Job Duties and Responsibilities:
- Identifies procedures and principal diagnosis performed on each patient and properly codes each procedure.
- Prepares batch for dates of services, posts, balances and closes for the day.
- Participates in USPI EDGE program.
- In conjunction with the Medical Records Specialist is responsible for assembling medical chart upon completion, reviews each chart for completeness, and obtains missing signatures or documents in a timely manner.
- Prepares charts for doctor's signatures, maintains medical record files, and is responsible for all aspects of its confidentiality.
- Obtains and files all reports generated by outside vendors.
- Submits charges on patient accounts to correct payer based on the verified insurance information. Performs re-bills to insurance payers and patients as needed and supplies additional information as requested.
- Maintains and checks implant tracking log and charges for implants or supplies not included in procedure fee.
- Updates and maintains master copy of all current forms used at the Center.
- Updates charge master for new/deleted procedure or diagnosis codes.
- Mails infection control survey to surgeons, keeps track of statistics, and informs the Clinical Manager of any reported infections. Prepares report for the PI Committee and MEC.
- Obtains surgeon signatures on Operative Reports and completes the Medical Record.
- Maintains log of outstanding Operative Reports and prepares report for the MEC.
- Assures that new physicians have transcription number and information. Resolves any problems with the transcription service.
- Is knowledgeable about current coding conventions and applicable state and federal laws as they pertain to billing, coding and consents.
- Backs up Accounts Receivable representative as needed.
- Receives, screens, and routes incoming calls in a professional manner by the third ring.
- Informs Business Office Manager of applicable day-to-day situations.
- Follows employee health, safety, personnel, and staffing policies.
- Successfully works as a team member.
- Shall be flexible, reliable, productive, patient-oriented and self-motivated.
Qualifications: To perform this job successfully, an individual shall be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and /or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Job Behavior: This person shall be able to communicate directly and professionally. Shall be flexible, reliable, productive, patient-oriented and self-motivated. Avoids being involved in gossip spreading or conversations that promote discord of staff members. Maintains professional conduct and appearance.
Experience and/or Education: Shall be a high school graduate. RHIT or ART preferred. Shall have one-year experience in ambulatory surgery center billing, collections, and medical records experience. Demonstrated proficiency in the most current coding conventions on ambulatory surgery medical records. Knowledge of third party billing, including Medicare, Managed care, commercial, Worker''s compensation and state Medicaid programs. Capable of operating 10 key calculator and demonstrated computer skills.
Language Skills: Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information on one-on-one and small group situations to patients, physicians, and other employees of the Center.
Reasoning Ability: Shall be able to apply common sense understanding to carry out detailed written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
Physical Demands: The physical demands described here are representative of those that shall be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The employee shall regularly be required to sit, use hands and fingers to handle or feel object and tools. The employee is required to stand, walk, climb or balance, stoop, kneel, crouch, or crawl. Shall be able to hear and speak. The employee shall be able to occasionally lift and /or move up to 20 pounds.
USPI''S EDGE- (Every Day Giving Excellence)
USPI''S EDGE- is the key to the differentiation of USPI as a customer-focused company. The process of completing EDGE- requirements establishes processes and measurements that are collected, assimilated, and shared throughout USPI. All employees are involved with EDGE-. The involvement can range from doing their jobs to taking on the role of gathering and/or entering data into the computer. All employees shall at some time during their employment be required to participate in the EDGE- program.
Health Insurance Portability and Accountability Act of 1996
Responsible for knowing the processes involved assuring the standards established by HIPAA, and ensuring they are followed including the practices and records relating to the use and disclosure of Protected Health Information.
Work Environment: The work environment characteristics described are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.