Job Description

Staff Position Description

Position Title: Specialty Biller

Position Purpose:

All KHI employees are expected to perform their respective tasks and duties in such a way that supports KHI’s vision of providing the region’s best clinical care and patient service through an environment that fosters respect for others and pride in performance.

This position is responsible for processing claims to ensure the accurate and timely billing of services.

Key Responsibilities

I. Service and Process Improvement:

A. Provides excellent customer service and adheres to the Behavioral Expectations Agreement and the mission, vision, and values of KHI

B. Assists in process improvement to bring about greater billing efficiency and accuracy.

C. Participates in business division meetings, performance improvement activities and committees as assigned. Communicates issues with incorrect or unclear information within training materials.

D. Utilizes Issues Log or other requested means of communication regarding issues, when necessary.

E. Performs other job duties, as assigned, to help meet the team’s goals and objectives.

II. Accuracy:

A. Reviews UB04s, CMS 1500s, and/or itemized statements for completeness, efficiency, and accuracy.

B. Reviews claims for reasonableness of charges and obtains supporting medical documentation for claims when necessary.

C. Contacts employers, payers, and/or patients for updated claim information.

D. Bills clean claims for Acute and Ambulatory Medicare, Home Health, Hospice, Corporate, Indian Health, and/or Liability services.

E. Bills secondary insurance, when appropriate.

F. Works rejection reports, including correction of demographic information, to ensure appropriate billing.

G. Works rejection reports to re-bill claims accurately.

H. Appropriately works the accounts receivable and denials.

I. Adheres to policies and procedures to achieve departmental and hospital goals.

J. Reviews training materials periodically to ensure accuracy and compliance with updated billing procedures.

K. Uses Direct Data Entry (DDE) to resolve billing issues for Medicare claims.

L. Meets established accuracy metrics as communicated by management. Metrics may differ depending on biller level.

III. Timeliness:

A. Understands contracts and payer specific guidelines in order to ensure timely follow up to avoid untimely denials and delays in cash flow.

B. Maintains and facilitates communication within the business and clinical divisions.

C. Completes timely follow up on accounts, resolved denials, and/or other correspondence.

D. Responds professionally and within appropriate time frames to telephone, e-mail, and task inquiries.

IV. Productivity:

A. Meets productivity standards for sending out bills daily, working billing reports, and correcting rejections efficiently.

B. Meets productivity standards for working outstanding accounts and denials in an effort to achieve claim resolution.

C. Meets established productivity expectations as communicated. Metrics may differ depending on biller level.

Qualifications

· High school graduate or equivalent required.

· One (1) year of medical billing and/or collections experience required.

Level I

· Demonstrates ability to communicate effectively with all types of customers, to manage multiple priorities and tasks, and to maintain attention to detail.

· Demonstrates knowledge of and ability to use computer hardware and software applications.

· Demonstrates improving proficiency in billing by meeting required departmental standards. These standards will be measured by formal and informal audits.

Level II:

In addition to meeting the qualifications for a Level I Specialty Biller, a Level II Specialty Insurance Biller must:

· Provide verification of completion of the Core and Specialty Training Program.

· Demonstrate advanced proficiency in billing by meeting required departmental standards. These standards will be measured by formal and informal audits.

Level III:

In addition to meeting the qualifications for a Level II Specialty Biller, a Level III Specialty Insurance Biller must:

· Provide verification of completion of the Core and Specialty Training Program.

· Demonstrate advanced proficiency in billing by meeting required departmental standards. These standards will be measured by formal and informal audits.

· Demonstrate the ability to effectively train and lead other employees in a manner which meets the mission, vision, and values of KHI.

Preferences

Working knowledge of Medicare billing practices in a Hospital, Physician Clinic System, Home Health, and/or Hospice Setting.

Date Staff Position Description Created / Revised: 7/5/2018