• Department: Billing
• Exempt/Non-Exempt: Non-Exempt
• Reports to (title): Billing Department Manager
• Supervises (titles): None

Position Summary:

Responsible for insuring maximum payment from insurance companies by reviewing explanation of benefits and following up with appeals as needed. Responsible and accountable for compliance with regulations mandated by governmental agencies as well as Policies and Procedures established by the Board of Directors of SMSC.

Responsibility/Standards of Performance:

Weight Responsibility Standards of Performance

(percentage of time spent on specific duty and standard employee is held to in performance of duties)

90% Tasks/AR/ Appeals

Process 100% of tasks within 48 hours of receipt for proper reimbursement and/or appeal write back. Research accounts for accuracy. 100% accuracy of follow up must be maintained on a timely basis. Work all unpaid balances and work all credits on a monthly basis. Appeals that do not require research are to be completed within 48 hours. Appeals requiring research are processed within 96 hours. 100% accuracy of follow up must be maintained. Enter comments and all pertinent information into computer at time received. Must be current 100% of the time. Locking & Billing Privia Tickets. Work Privia Tasks.

10% Customer Service/other duties assigned/Special Projects

100% of the time. Attend seminars and workshops as requested as well as read printed material as available to stay current on issues and changes in Billing. 100% of the time -Responsible for treating others politely and with respect. Must always remain professional, polite and considerate of patient needs. Must have the ability to listen and respond concisely, yet accurately to questions asked. Responsible for problem solving and not letting patient expectations go unmet. Demonstrate a desire to be responsive, make others feel welcome and that you are eager to help them. Get along well with patients, providers and co-workers.

G/7: Access to email, web surfing, time card, work order tracking system and interoffice instant messaging. Full access to patient Billing and financial data. Access to medical data is limited to templates, documents and scanned information specified as pertinent to job duties. Limited ability to add information to the patient chart, no ability to modify or delete data entered by another user. May have access to view and print patient data in Orchard Harvest and PACS, as provided by Lab/Xray department managers, as needed for job function. (Cashiers, Bus Offc, Mngd Care, Ins, EPM/EDI OB)

Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities of this job at any time.

Position Qualifications:

• High School Diploma or equivalent
• Computer proficient with ability to type 35 WPM
• General knowledge of billing department functions with focus on claims reimbursement and filing procedures. Knowledge of Medicaid claim reimbursement and filing procedures and knowledge of government rules for Medicaid a plus.
• Knowledge of ICD-10 and CPT codes a plus
• Detail oriented with ability to work independently and meet deadlines
• Travel to out-of-town meetings to attend workshops and seminars
• Good communication skills with ability to interact in a positive manner with Billing company and/or governmental agency representatives, patients and co-workers
• Perform job duties and maintain professional demeanor
• Ability to sit for extended periods of time using computer and telephone
• Maintain regular attendance and meet the attendance requirements of the job
• Think rationally and reason logically
• Maintain absolute confidentiality

Working Conditions:

Office environment, fast pace; telephone contact with insurance companies.