Under general supervision, prepares and submits patient claims to appropriate third party payers. Reviews claims to ensure that payer specific billing requirements are met. Resolves routine and non-routine patient billing inquiries and problems. Follows standard procedures and pre-established guidelines to complete tasks. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards, and US Oncology*s Shared Values.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
-Collects patient documentation and charts for claim submission. Ensures claim forms are completely and accurately filled out. Updates and maintains patient billing data and ensures documents are current.
-Reviews patient charts for completeness. Contacts clinical staff for clarification on procedures or diagnosis and on missing information.
-Enters charges, processes, and submits insurance claims to third party payer. Completes data entry of the charges into Practice Management System. Completes review of interface transactions and resolution of TES edits. Verifies that initial claim is accepted by third party payers. Reviews reports for claim denials.
-Identifies and reports any payer trends, denial patterns, and delays to management.
-Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patient*s records and collections.
-Responsible for maintaining current billing, coding, and standard operating procedures (SOP) files as a desk reference.
-Other duties as requested or assigned. May perform payment responsibilities.
High school diploma or equivalent required. Minimum of two (2) years medical billing and payment specialist or equivalent experience required. Medical coding experience preferred. Proficiency with computer systems and MicroSoft Office (Word and Excel) required.
-Working knowledgeable of state, federal, and third party claims processing required
-Must successfully complete required e-learning courses within 90 days of occupying position.
-Uses Technical and Functional Experience: Possesses up to date knowledge of the profession and industry; accesses and uses other expert resources when appropriate.
-Demonstrates Adaptability: Handles day to day work challenges confidently; is willing and able to adjust to multiple demands, shifting priorities, ambiguity and rapid change; shows resilience inn the face of constraints, frustrations, or adversity; demonstrates flexibility.
-Uses Sound Judgment: Makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty.
-Shows Work Commitment: Sets high standards of performance; pursues aggressive goals and works efficiently to achieve them.
-Commits to Quality: Emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluated products, processes, and service against those standards; manages quality; improves efficiencies.
The physical demands described here are representative of those that must 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. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.
The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites.
The US Oncology Network is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
33132.02 - 40347.52
Billing Clerk / Specialist
Billing Clerk / Specialist
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