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Lead Clerk CCMC Billing

3 months ago

Erlanger, United States St. Elizabeth Healthcare Full time

Lead Responsibilities

* Communicates with supervisor/Manager and payers of any issues that would prohibit claim payment. * Completes work list with the correct activity code, tickle date, phone number and account notes. * Demonstrates adequate, appropriate, and professional levels of communication with insurance company representatives, team members, supervisors, and managers. * Elevates serious barriers to claim resolution to appropriate management * Assists other associates when necessary, as determined by manager, works with staff to identify and resolve issues and develop standard practices * Maintains 91+ Agings at Management established best practice levels. * Completes special projects & tasks by the established time frame which can include organizing workload and/or associates for successful account resolution: proactively notifies supervisor of any barriers that prohibit billing and/or payment of claims. * Complex review of accounts for maximum reimbursement. * Completes other tasks and duties as assigned by manager * Assumes duties of supervisor/other lead as needed. Assists co- worker in problem solving, with reports and work lists, meetings, etc. * Execute training of contracted staff (internal and external). * Serves as a backup in the absence of staff members. * Assign, monitor / review the task progress and ensure accurate work of a group of employees. * Provide instruction so others on the team can complete tasks quickly and effectively. * Inform management of overall performance of team members * Answer questions, offer insight and organize responsibilities within the team. * Provide technical guidance on more complex issues. * Lead the day-to-day operations of a group of employees. * Responsible for corporate accounts billing/Follow-up, maintaining contacts and staying current with changing guidelines * Responsible for combining consecutive accounts, maintaining guidelines and staying current with changing regulations

Team Quality

* Reviews bills and related information for accuracy and reasonableness of charges * Audit claims for overlap (charges, dates, coding, condition codes, modifiers, discharge status) and resolves issues with medical records and revenue department heads. * Reviews Therapy Accounts (forms, charges, onset dates of service, value codes, Occurrence codes) working closely with department heads to resolve issues. * Audit Charity Accounts for correct adjustment and accurate qualification * Create and maintain Procedures for the department * Provide training for outside vendors

Billing Responsibilities

* Work Specific Reports (as applicable) * Submits bills to payers electronically if possible, otherwise paper * Proficient in Commercial/Medicare/Medicaid Government regulations and reimbursement policies * Proficient in third party contractual agreements and regulations to apply requirements for accurate billing and to make recommendations for system changes as needed * Assist Medical Records and Revenue Department on high dollar claims, changing DRG, coding, and charges on processed claims including but not limited to Consecutive Account management, Follow-up Vendor Account management and Reimbursement Account management. * Responsible for corporate accounts billing/Follow-up * Reviews bills and related information for accuracy and reasonableness of charges

Follow-Up Responsibilities

* Calls payers/ Patients or uses online resources to obtain status on accounts housed on work lists. * Records appropriately detailed notes in the billing system * Takes appropriate action to resolve claims, i.e., the representative will execute any and all steps to resolve unpaid claim, including but not limited to; rebill of claim. * Initiate appeals when necessary or works with Utilization Management / Risk Management for appropriate appeal process. * Calculates expected reimbursement/ Adjustments on accounts if/when necessary. * Facilities, generate spreadsheets/ invoices, track * Payment/nonpayment. * Establishes relationship with payer contacts * Establish Relationship with other Departments * Performs due diligence on all collection efforts * Ensures expected reimbursement is secured

Communication/Trending

* Trends weekly productivity, Billing CFB, Follow-up agings * Edit WQs (Securing required data necessary for billing.) * Assist in training staff * Completes KPI forms * Attends weekly billing staff meetings * Identifies payer & billing issues * Participates in a positive & constructive manner * Responds to internal and external customer calls or concerns. * In the absence of management will lead meetings and other operational issues.

Continuing Education & Training

* Seeks opportunity for training & informs supervisor of all training needs. * Attends Seminars and workshops as assigned by manager, to obtain billing and/or follow up information related to specific payers

Performs other duties as assigned.

Education, Credentials, Licenses:

* High school diploma or equivalent and or business courses

Specialized Knowledge:

* Experience in hospital third party billing and follow-up; PC skills; Word/Excel. detail oriented; customer service skills; communication skills; familiarity with managed care contracts and environment; knowledge of situation response guidelines.

Kind and Length of Experience:

* Minimum 3 years experience in self pay/insurance follow up activities

FLSA Status:

Non-Exempt

Right Career. Right Here. If you're looking for the right careers in healthcare, the right place to be is at St. Elizabeth. Join us, and you'll take pride in the level of care we offer our community and dis