1. Prepares and submits hospital and hospital based physician claims to third-party insurance carriers either electronically or by hard copy billing.
2. Secures needed medical documentation required or requested by third party insurances.
3. Follows up with third-party insurance carriers on unpaid claims till claims are paid or only self-pay balance remains.
4. Processes rejections by either making accounts private and generating a letter of rejection to patient or correcting any billing error and resubmitting claims to third-party insurance carriers.
5. Works with physician or medical record staff to ensure that correct diagnosis/procedures are reported to third party insurance carriers.
6. Makes accounts private and notify patients when claims have not been paid after time frames in established accounts receivable policy.
7. Keeps updated on all billing and benefit changes for third-party insurance carriers.
8. Posts third-party insurance remittance vouchers.
9. Monitors claims for missing information and authorization/control numbers.
10. Maintains confidentiality of all information.
11. Completes work within authorized time to assure compliance with departmental standards.
12. Keeps updated on all third-party billing requirements and changes for insurance types within the area of responsibility.
13. Demonstrates knowledge of, and supports, hospital mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality standards, and the code of ethical behavior.
14. Maintains third-party billing logs.
Required Education and Experience [Indicate education based on requirements that are job-related and consistent with business necessity. See examples below.]
1. Successful completion of high school or commercial coursework including math, bookkeeping and business.
2. Post high school courses in insurance billing, data processing and medical terminology preferred. Courses in insurance billing, data processing and medical terminology preferred.
3. One year of prior experience in billing of third-party insurances for facility and professional services required.
4. Knowledge of third-party billing requirements