This position performs all phases of Third-Party billing and Follow-up on services provided by EVMS Medical Group clinical staff, assists the Manager of the Department in the delegation of tasks to the Patient Account Representatives, and acts as "Team Leader" for the established Insurance teams.
(Same tasks as the PAR with the additional responsibility of assignment of duties to PARs and monitoring their productivity and results.)
Billing Function Responsible for the training of new employees and assist PARs when problems arise. Responsible for adding and editing the various IDX dictionaries to ensure that accurate insurance and provider data is stored. Responsible for the research, review and adjustments to patient accounts. Responsible for the electronic and manual billing to Third Party Payers in a timely, proficient fashion. Review all manual claim forms for accuracy prior to the claim submission. Understand the required attachments to claims, as they relate to CPT, ICD10 and modifier coding practices. Review claims for appropriate documentation attachments. Ensure that all carrier requirements are supported with claims submitted. Communicate with the EVMS Medical Group clinical departments, hospitals, and patients to secure insurance data and/or medical documentation required to file claims. Work closely with the IT staff to ensure that electronic claims submission processes are operating smoothly. Identify electronic problems and assist in the determination of resolutions. Operate the Touchworks Scan filing system to retrieve required documentation, referrals and/or other pertinent data required to file claims. Review IDX claim edit lists to make the necessary corrections to data input errors or missing information. Post the "insurance billed" paycode to all manually filed claims. Post the "Appeal Sent" paycode to all Appealed claims. Insurance Follow-up functions: Responsible for the timely follow-up, account research, and resolution of outstanding Third Party claims. Maintain an ETM workfile, as assigned by the Insurance Department Supervisor. Identify and correct any CPT/ICD10/Modifier coding error that prohibits the claim(s) from the final adjudication process. Coordinate the exchange of insurance information with the EVMS Medical Group clinical departments to expedite claim processing. Identify appropriate adjustments to patient accounts for submission to Patient Accounts Manager. Prepare insurance claim forms and/or tracers on unpaid invoices in a timely fashion. Handle incoming calls from the insurance carriers and respond to their requests in a timely manner. Perform error corrections to accounts when applicable. Act as Supervisor in her/his absence. Other duties as assigned. ON THE JOB TRAINING: IDX system's training session. ETM system's task and rejection sub-system training. EVMS Medical Group clinical structure, policies and procedures. High School graduate with at least three years' experience in a Health Care billing and collections environment. Knowledge of Third-Party Payer rules and regulations. Knowledge of CPT and ICD10 coding practices. A minimum of 45 WPM typing ability. Good interpersonal skills. Appreciation for confidentiality. US-VA-Norfolk
