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Role Description

The position, under the supervision of the Manager of Hospital Billing, performs extensive analysis and various follow-up activities to ensure the integrity of reimbursement of medical services provided by the hospital.

• Identifies payment variances and works internally and externally to resolve such issues and recover underpayments.

Qualifications

• Associates degree and five (5) years of provider billing and revenue cycle experience OR High school diploma or equivalent and seven (7) years of provider billing and revenue cycle experience
• Basic-level Excel skills (preferred)
• One (1) year of Epic experience (preferred)

Requirements

• Identifies and analyzes payment variances, working closely with third party payers to resolve issues and ensure correct reimbursement.
• Recovers underpayments.
• Works with other hospital departments on issues related to payment integrity.
• Analyzes and gathers supporting documentation to process appeals to third parties, and follows up with payers accordingly.
• Performs research and analysis related to billing and reimbursement.
• Maintains current knowledge in the areas of third party billing, reimbursement schedules and methodologies, coding, payer contracts, billing and payment rules and regulations, and hospital billing compliance.
• Assists with special projects as assigned.

Skills & Abilities

• Analytical and research skills.
• Working knowledge of medical terminology and coding, including CPT, DRG, Revenue Codes, and ICD-10 codes.
• Experience working with third party payers to resolve ongoing issues.
• Basic knowledge of billing guidelines, rules, and payment policies.
• Strong verbal and written communication skills.
• Adequate time management and organizational skills.
• Experience working with computer systems and programs.

Job Profile Summary

This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this role focuses on performing the following Revenue Integrity duties:

• Responsible for compliantly maximizing financial reimbursement for clinical services provided to patients.
• Identifies financial reimbursement degradation, maintaining fee schedules, etc.
• An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a “hands on” environment.
• The majority of time is spent in the delivery of support services or activities, typically under supervision.
• An experienced level role that requires basic knowledge of job procedures and tools obtained through work experience and may require vocational or technical education.
• Works under moderate supervision, problems are typically of a routine nature, but may at times require interpretation or deviation from standard procedures, and communicates information that requires some explanation or interpretation.

Pay Range

$66,397.24 - $82,991.27