Company :

Job Description : 

GENERAL OVERVIEW:

This job processes pro-fee billing activities.

ESSENTIAL RESPONSIBILITIES:

• Posts co-payments, patient payments, and insurance company payments (paper and electronic), and denials. Performs reconciliation of payments. Prepares and deposits payments received.
• Uses CPT, ICD-9, and payer specific codes and modifiers to prepare and enter charges for entry (includes office, hospital, and outpatient charges).
• Assists customers with patient billing inquiries. Identifies unpaid balances (insurance and patient) through A/R reports and takes appropriate actions.
• Obtains and enters patient demographic, insurance, and referral/precertification information in the billing system.
• Verifies insurance information via hospital and insurance carrier systems. Ensures that electronic and paper claims are sent to insurance carriers in a timely manner.
• Maintains current knowledge of federal and state reimbursement policies/regulations and system policies pertaining to billing. Ensures compliance with regulatory requirements.
• Performs all other duties as assigned, including but not limited to supporting front end office processes.

QUALIFICATIONS:

Minimum

• High school diploma or GED; or one to three months related experience and/or training; or equivalent combination of education and experience.
• 1-3 years’ healthcare billing experience.

Preferred

• Graduate of a medical billing program.
• Medical Records training and OASIS education.

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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