Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time).

Pay Range:

Scheduled Weekly Hours:

Position Overview

Responsible for all aspects of claim submission for services rendered at Capital Health through the Revenue Cycle life cycle to all payers, including but not limited to pre and post claim review, claim (277) rejections, denial review, and claim resubmission. Provides, elicits, and gathers information to facilitate, expedite, and obtain professional payments from third party carriers. Performs collection and follow-up activity with insurance companies. Completes necessary billing projects as assigned. Meets internal and external customer expectations.

MINIMUM REQUIREMENTS
Education:    High school diploma or equivalent.
Experience:    One year' previous healthcare billing experience in a hospital, professional, or medical office setting.
Other Credentials:    
Knowledge and Skills:    
Special Training:    Working knowledge of Microsoft office and excel. Experience using Electronic Medical Record (EMR) software. Cerner, Athena, Epic preferred.
Mental, Behavioral and Emotional Abilities:    Can work well independently and in team settings.
Usual Work Day:    8 Hours  
Reporting Relationships
Does this position formally supervise employees? No

If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.

ESSENTIAL FUNCTIONS
Responsible for all primary and secondary claims submitted to payers according to insurance requirements.
Analyzes claims for errors during all stages of submission for accuracy of billing. Maintains current knowledge of payer requirements
Demonstrates comprehensive understanding of team functions and specialized terminology of third-party payers.
Works closely with appropriate staff/departments to make corrections and ensures accuracy for the days’ work (ex: coding and patient access: CCI edits, Medical Unlikely edits, demographic information, date of birth, etc).
Resolves all Return to Provider (RTP) claims in error in the Medicare Fiscal Intermediary Shared System (FISS) on a daily basis (hospital only). Resolves New Jersey Discharge Data Collection System (NJDDCS) MIDS errors on a routine basis as defined by management (hospital only).
Verifies covered days (hospital) and services to be rendered (hospital/professional) prior to submitting claims in a timely manner. Corrects errors from the daily claim (277) rejections or escalates to the appropriate department for resolution.
Reviews hospital billing reports for corrections needed in order to have the accounts final bill – these includes but are not limited to: Late Charge report, 72-hour report, etc. to ensure claims are billed timely and accurately (hospital only).
Evaluates, reviews, and analyzes patient accounts to determine if third party payments have been received, recorded, and are appropriate based on contractual expectations. Review patient’s account in totality, including demographic information, service rendered, insurances documentation, etc to gain full understanding of the patient’s A/R.
Performs appropriate follow-up which could include calls to payers, claim review on payer portal, manual adjustment to account balance and financial class changes, where relevant. Answers calls and other inquiries from payer representative timely regarding accounts and completes proper documentation of all activity on each account.
Identifies and communicates payment variances, error trends, and account issues for resolution to management. Identifies denial trends and reports them to management to allow for more efficient billing and timely resolution.
Reviews credit balances for adjustments, refund and/or claim adjustment submission as assigned. Researches and retrieves appropriate documentation (e.g. authorizations, medical records) for appealing denials.
Works correspondence as assigned and escalated by correspondence team. Communicates denials and other issues with the appropriate Revenue Cycle department and/or physician representative to address root causes.
Documents clear and concise notes in the billing system. Operates other relevant computer software efficiently to complete required billing and follow-up tasks.
Enters charges into Billing System from various reports, where relevant. Performs assigned worklists and other duties quickly and accurately showing attention to details and is sufficiently organized to produce quality work.
Maintains assigned productivity standards and escalates obstacles in accomplishing expectations in a timely manner.
Prioritizes and updates files and other required documentation in accordance with established policies, guidelines, and procedures.
Demonstrates willingness to adapt to changing departmental demands as new billing duties are required.
Completes special assignments and projects with minimal supervision and consistently meets targets.
Performs other duties as assigned and adapts to changing departmental demands.

PHYSICAL DEMANDS AND WORK ENVIRONMENT
Frequent physical demands include: Standing , Walking , Talk or Hear

Occasional physical demands include: Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl , Wrist position deviation

Continuous physical demands include: Sitting , Pinching/fine motor activities , Keyboard use/repetitive motion

Lifting Floor to Waist 20 lbs. Lifting Waist Level and Above 10 lbs.

Sensory Requirements include: Very Accurate 20/40, Near Vision, Accurate Far Vision, Color Discrimination, Minimal Depth Perception, Minimal Hearing
Anticipated Occupational Exposure Risks Include the following: N/A
 

This position is eligible for the following benefits:

• Medical Plan

• Prescription drug coverage & In-House Employee Pharmacy

• Dental Plan

• Vision Plan

• Flexible Spending Account (FSA)

- Healthcare FSA

- Dependent Care FSA

• Retirement Savings and Investment Plan

• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance

• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance

• Disability Benefits – Long Term Disability (LTD)

• Disability Benefits – Short Term Disability (STD)

• Employee Assistance Program

• Commuter Transit

• Commuter Parking

• Supplemental Life Insurance

- Voluntary Life Spouse

- Voluntary Life Employee

- Voluntary Life Child

• Voluntary Legal Services

• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance

• Voluntary Identity Theft Insurance

• Voluntary Pet Insurance

• Paid Time-Off Program

The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. 

The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.