Job Description

Independently coordinates and performs multiple complex functions within the Central Billing department. Utilizes considerable judgment in interpreting departmental policies to resolve routine to complex inquiries or patient account problems. Identifies opportunities for process improvements, offers and implements solutions. Mentoring and coaching team members to identify and complete lean process improvements. Participates and coordinates meetings as a representative of the department. Serves as the primary resource to team members for training, complex patient accounts, etc. Performs all duties in a manner that promotes a team concept and reflects the mission, behaviors, core values, and philosophy of CT Children’s Medical Center and Ct Children’s Specialty Group.

As a representative of CT Children’s, you must have the ability to deal compassionately and professionally with patients and families. Following department protocols. Performs and manages with limited supervision a variety of administrative support activities in support of the professional billing team.
Maintains privacy and confidentiality by abiding by HIPAA policies and the standard billing code of conduct. Independently creates the delegation of tasks or work assignments as needed. Independently identifies trends in process opportunities and provides educational training to team members for improvement. Ensures all outstanding issues are resolved in a timely manner. Acts a liaison with CFC, Revenue Integrity (coding), CCSG practices and customer service for denials and account problem resolution.

BILLING FOLLOW UP
Reviews and maintains billing processes to establish timely cash collections with the payer.
Analyzes accounts daily to ensure all claims are worked within 30-45 days and target goal, as set by Manager, is met. Audits delinquent and aging insurance claim reports, researches and reconciles outstanding accounts to resolve issues and determine if adjustment, correction, or rebilling should take place. Follows through with third party payers to resolve payment issues and ensure timely receipt of payments. Retrieves all medical documentation and initiates appeal process when appropriate. Seeks ways and opportunities to increase productivity and efficiency, while maintaining or improving quality.
Identifies and directs, based on payer policy guidelines, all requests for write-offs to management for approval. Initiates contact with provider reps when appropriate to resolve difficult claim issues. Productivity expectations: 19-23 accounts per day or 95-115 weekly on average. Depending on assigned task each day, counts may vary.
Other duties as required.

Will be back up for the assistant manager when it comes to any daily tasks such as call outs, time off requests, help in designated work ques, urgent matters, etc. May be responsible to coordinate daily activities of the department; delegate assignments to staff; and serve as a primary resource to staff.
First level resource to staff and various leadership regarding daily processes and issues. Performs Quality Assurance (QA) & training for new and existing team members with periodical check in’s. (Training materials in shared folder) .Active participant of minimum 1 hospital committee; shares departmental and/or organizational initiatives with team members. Will assist/lead in 1-2 monthly meetings/trainings for team members. Responsible for ensuring standard work/job aide processes are up to date, accurate, and include all pertinent information of performing job duties at staff level.

Education Required: High School Diploma or GED is required.

Experience Required: 2-4 years directly related experience required and healthcare experience required.

Experience Preferred: 1 year of CT Children’s direct related experience preferred.

KNOWLEDGE OF
* ICD-10, CPT, Medical terminology
* EPIC systems preferred
* Payor policies and HCFA claim billing
* Common denial remittance code definitions
* Knowledge of MS Word and Excel
* Knowledge of Commercial payors, Medicaid and managed care plan.

SKILLS
* Computer, typing, data entry
* Excellent verbal and written communication skills
* Excellent organizational skills
* Ability to provide and receive constructive feedback
* High organized, with excellent time management and prioritization abilities

ABILITY TO
* Handle a fast paced, high volume environment
* Work in a team environment alongside multiple disciplines
* Coordinate workflows, anticipate and reassign/balance workloads
* Provide continued guidance and training to staff and delegate effectively
* Independently able to have crucial conversations with others/staff