ProFee Billing Specialist
Position Purpose: Responsible for initiating automated claims processing activities using claims editing software for all CHP claims in an efficient, accurate and time-conscious manner while maintaining daily and weekly productivity standards established within the PFS department for this position.
Essential Functions (list in order of importance including measures)
- Ensures that claims are transmitted electronically each day to the appropriate payer. Ensures that claims that cannot be billed electronically, are printed and mailed as needed. 70%
- Researches, edits/corrects and transmits any claims rejected by the claims editing software in order to submit them timely to the appropriate intermediary, which may include Medicare, Blue Cross, managed care commercial, and other carriers. 20%
- Ensures claims, missing diagnosis or other required information are forwarded to the Manager. Reports recurring system problems relating to the host system, the electronic billing system and payer problems to Manager for review and resolution. 4%
- Documents activities as appropriate in the collection notes and workstation of the system. Assists with claims downloaded from the host system. Prepares and prints daily and weekly production, management and system reports as required. 5%
- Assists with balancing and reconciling claims processed as necessary. 1%
Marginal Functions (list in order of importance)
- Performs both essential and marginal job functions in a safe manner as identified by Saint Anthony Hospital and the respective department while adhering to the Hospital’s confidentiality norms and standards. Actively and consistently demonstrates the core values of Saint Anthony Hospital in all interactions with others.
- Assumes responsibility for knowing and maintaining established hospital and departmental objectives and policies/procedures, including general sanitation, safety, environmental and infection control standards.
- Participates in performance activities including problem identification, data collection, solution selection, implementation and evaluation. Also, assists in the care and maintenance of departmental equipment and supplies as appropriate.
- Participates in staff meetings and other in services, meetings or committees as required.
General Job Requirements (List any required knowledge, skills, experience or training, including length of time necessary for proficiency, required to perform the job.)
- Previous experience performing hospital billing
- Knowledge of CMS, Medicaid, Managed Care, and Commercial billing guidelines.
Reporting Relationship
Positions reporting to this position include: None
Machines, tools, equipment and work aids required: General office equipment; Other Equipment Includes:
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