Job Information
National Jewish Health Insurance Biller in Denver, Colorado
Position Summary
Performs all aspects of third party payor medical billing and ensures accurate and timely billing of receivables. Audits and bills claims according to federal, state, and payor regulatory and compliance requirements.
Essential Duties
Executes patient accounting system downloads and claim editing software daily procedures on a rotation basis with other insurance billers. Reconciles data from patient accounting systems to claim editing reports and resolves any discrepancies. Identifies and reports any system network problems to Application Analyst or Supervisor. Has a thorough understanding of CPT, HCPCS & ICD-10 codes, HCFA and UB04 claim forms and can understand payor EOBs and ERAs. Performs team's third party payor billing (primary, secondary, tertiary) using claims editing software. Reviews claims for accuracy and completeness and obtains any missing information. Facilitates submission at time of billing for medical records or other documentation when required by payor for appropriate claims processing. Evaluates and researches claims billing denials and reject reports in a timely manner. This includes pulling patient insurance information, verifying patient eligibility, researching payor websites, and/or calling payors for assistance regarding the denial or reject reasons. Researches incomplete charges, registration, or diagnosis information with responsible department and ensures resolution before submitting claim to payor. Maintains a current and thorough working knowledge of federal, state and payor billing regulatory and compliance requirements. This includes HIPAA & EDI requirements, with emphasis on billing transaction standards 837i and 837p. This includes signing up for payor newsletters and list serves. Reviews managed care contract matrix for contract and billing changes. Comprehends and demonstrates ability to comply with governmental billing requirements such as Medicare OPPS and CCI/OCE claim editing. Attends external and internal education programs when necessary. Communicates regularly with the Patient Financial Services (PFS) Supervisor or Manager regarding high-risk accounts. Identifies and refers accounts and billing problems to the Billing Supervisor when routine guidelines to correct problems are not producing results.
Other Duties
Assists the PFS Supervisor when reviewing various reports in the patient accounting system and billing to identify problems within accounts that prevents the claims release in order to avoid time filing problems. Identifies and reports to supervisor incorrect insurance data entry trends in patient accounting system and identifies incorrect insurance information in the patient accounting system and claims editing software Insurance Directories. Provides PFS Supervisor with weekly productivity statistics and reports workload fluctuations (backlog or shortages) in a timely manner. Maintains individual goals established by PFS management. Performs as a back-up to staff absences and vacancies, as necessary.
Competencies
Accountability: Accepts full responsibility for self and contribution as a team member; displays honesty and truthfulness; confronts problems quickly; displays a strong commitment to organizational success and inspires others to commit to goals; demonstrates a commitment to Patient Financial Services Departments and National Jewish Health. Adaptability: Maintaining effectiveness when experiencing major changes in work responsibilities or environment; adjusting effectively to work within new work structures, processes, requirements, or cultures. Attention to Detail: Accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time. Setting high standards of performance for self and others; assuming responsibility and accountability for successful y completing assignments or tasks; self-imposing standards of excellence rather than having standards impos Collaboration/Teamwork: Cooperates with others to accomplish common goals; works with employees within and across his/her department to achieve shared goals; treats others with dignity and respect and maintains a friendly demeanor; values the contributions of others. Decision Making: Identifying and understanding issues, problems, and opportunities; comparing data from different sources to draw conclusions; using effective approaches for choosing a course of action or developing appropriate solutions; taking action that is consistent with available facts, constraints, and probable consequences. Initiative: Taking prompt action to accomplish objectives; taking action to achieve goals beyond what is required; being proactive. Managing Work and Time: Effectively managing one's time and resources to ensure that work is completed efficiently. Effectively manages project(s) by appropriately focusing attention on the critical few priorities; effectively creates and executes against project timelines based on priorities, resource availability, and other project requirements (i.e., budget); effectively evaluates planned approaches, determines feasibility, and makes adjustments when needed. Perseverance/Resourcefulness: Accesses and utilizes available resources inside and outside the company.
Supervisory or Managerial Responsibility
None
Travel
None