Medical Billing / Revenue Cycke

Performs day-to-day billing and follow-up activities within the revenue operations and coordinates with contracted billing service company. Duties include front end review of claims prior to submission, denial correction, cash collection reporting, A/R monitoring.

ESSENTIAL FUNCTIONS

Demonstrates the HomeTeam’s, Vision, and Values in behaviors, practices, and decisions.

Performs daily activities as part of the billing and follow-up team in support of the revenue cycle process.

Documents claims billed, paid, settled, and follow-up in appropriate system(s).

Identifies and escalates issues affecting accurate billing and follow-up activities.

Problem resolution - include contacting the payer directly for payment due on accounts and reviewing and responding to all mail correspondence in a timely and accurate manner.

Coordinates with external billing group to clarify billing discrepancies and obtains demographic, clinical, financial, and insurance information.

Coordinates with external billing group all routine follow-up functions which includes the investigation of overpayments, underpayments, credit balances and payment delays.

Researches claim rejections, make corrections, take corrective actions, and/or refer claims to appropriate colleagues to ensure timely and accurate claim resolution.

May prepare special reports as directed by the CFO and Follow-Up to document follow-up services, e.g., number of claims and dollars billed, claims edited, claims unprocessed, etc.

Code and prepare monthly invoices for various contracted clients.

Other duties as needed and assigned.

Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

MINIMUM QUALIFICATIONS

High School diploma and at least one (1) year of experience and relevant knowledge of revenue cycle functions and systems working within a physician practice or clinic environment, a health insurance company, managed care organization or other health care financial service setting, performing medical claims processing, accounting or customer service activities or an equivalent combination of education and experience. Experience in a complex, multi-site environment preferred.

Basic understanding of Microsoft Office, including Outlook, Word, PowerPoint, and Excel.

Completion of regulatory/mandatory certifications and skills validation competencies preferred.

Excellent verbal and written communication and organizational abilities.

Strong interpersonal skills are necessary in dealing with internal and external customers.

Accuracy, attention to detail and time management skills.

Ability to work independently.

Must be comfortable operating in a collaborative, shared leadership environment.