Job Description

Essential Duties and Responsibilities

• Performs daily posting of payments. Imports remits and reconciles payments.
• Stays current with payer requirements for billing and shares best practices. Is involved with root cause analysis of denied claims and communicates trends and suggestions for improvement.
• Review claim edits to achieve clean claims and timely submission to Payers.
• Processes and corrects insurance denials. Works Accounts Receivable account aging to achieve maximum reimbursement for services provided. Documents all efforts on patient accounts.
• Scans documentation into the archiving system for storage.
• Provides customer service to internal and external customers regarding claims and insurance processing. Works with departments to resolve and avoid denials and appeals. Collaborates with team members to make process decisions.
• Works with customers regarding billing questions.
• Works willingly and accepts assignments as given.
• Attends all mandatory meetings and programs.
• Participates in opportunities that enhance personal and professional growth.
• Performs other duties as necessary or assigned.
• Complies with the Corporate Compliance Policy and all laws, regulations, and Standards of Conduct relating to the position and agrees to report any suspected violations of law or Standards of Conduct.
• Complies with all applicable state and federal regulations and JCAHO standard.
• Maintains a safe work environment using safe work practices, utilizing standard precautions and complying with hazardous waste procedures at all times as described in St. Anthony's Safety Manual.
• Maintains the confidentiality of patient, resident, employee and organizational information.

Supervisory Responsibilities

This job has no supervisory responsibilities.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

• Medical billing and coding certificate, diploma, or equivalent Revenue Cycle Certification, with a minimum of 1 year related experience and/or training; or equivalent combination of education and experience.
• Must possess a basic knowledge of Insurance terminology, Reimbursement methodologies, Claims processes, and Remittance Advices.

Position Requirements, Licenses, Certifications, Registrations

• Effective communication skills.
• Basic computer skills, such as sending emails, typing, and using spreadsheets.
• Collaborate well with others.
• Problem-solving skills.
• Work independently.

Language Skills

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to create routine reports and correspondence. Ability to speak effectively before customers, patients, families and employees of the organization.

Physical Demands
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 regularly required to sit; talk and hear; reach with hands and arms; and use hands to finger, handle or feel. The employee is occasionally required to stand, walk, and climb or balance. The employee must be able to lift and/or move up to 10 pounds at times, and occasionally lift and/or move up to 35 pounds. Specific vision abilities required by this job include close vision, distance vision, depth perception, and ability to adjust focus. Computer work is frequent.

Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Regularly works in an office setting with frequent interaction with employees, board members, donors, volunteers, and the public.

Due to the nature of business in a health care setting, although risk is minimal, any employee of St. Anthony may be exposed to moving mechanical parts, fumes or airborne particles, blood borne pathogens, unpleasant sights, odors, and/or materials in patient care and/or provider work areas.

The noise level in the work environment is usually quiet.

Other Requirements
May be required to train in and float to other areas within the department or other assigned areas and provide extra support and/or coverage as needed.