Clinic Billing Specialist II

JOB PURPOSE OR MISSION: To review and prepare billing forms and ensure accuracy and completeness for electronic or hardcopy claims submission.

PERFORMANCE CRITERIA

CRITERIA A: Everyday Excellence Values

Employee demonstrates Everyday Excellence values in the day-to-day performance of their job.

• Demonstrates courtesy and caring to each other, patients and their families, physicians, and the community.
• Takes initiative in living our Everyday Excellence values and vital signs.
• Takes initiative in identifying customer needs before the customer asks.
• Participates in teamwork willingly and with enthusiasm.
• Demonstrates respect for the dignity and privacy needs of customers through personal action and attention to the environment of care.
• Keeps customers informed, answers customer questions and anticipates information needs of customers.

CRITERIA B: Corporate Compliance

Employee demonstrates commitment to the Code of Conduct, Conflict of Interest Guidelines, and the GHS Corporate Compliance Guidelines.

• Practices diligence in fulfilling the regulatory and legal requirements of the position and department.
• Maintains accurate and reliable patient/organizational records.
• Maintains professional relationships with appropriate officials; communicates honesty and completely; behaves in a fair and nondiscriminatory manner in all professional contacts.

CRITERIA C: Personal Achievement

Employee demonstrates initiative in achieving work goals and meeting personal objectives.

• Uses accepted procedures and practices to complete assignments. Uses creative and proactive solutions to achieve objectives even when workload and demands are high.
• Adheres to high moral principles of honesty, loyalty, sincerity, and fairness.
• Upholds the ethical standards of the organization.

CRITERIA D: Performance Improvement

Employee actively participates in Performance Improvement activities and incorporates quality improvement standards in his/her job performance.

• Optimizes talents, skills, and abilities in achieving excellence in meeting and exceeding customer expectations.
• Initiates or redesigns to continuously improve work processes.
• Contributes ideas and suggestions to improve approaches to work processes.
• Willingly participates in organization and/or department quality initiatives.

CRITERIA E: Cost Management

Employee demonstrates effective cost management practices.

• Effectively manages time and resources.
• Makes conscious effort to effectively utilize the resources of the organization — material, human, and financial.
• Consistently looks for and uses resource saving processes.

CRITERIA F: Patient & Employee Safety

Employee actively participates in and demonstrates effective patient and employee safety practices.

• Employee effectively communicates, demonstrates, coordinates and emphasizes patient and employee safety.
• Employee proactively reports errors, potential errors, injuries or potential injuries.
• Employee demonstrates departmental specific patient and employee safety standards at all times.
• Employee demonstrates the use of proper safety techniques, equipment and devices and follows safety policies, procedures and plans.

JOB FUNCTIONS

ESSENTIAL JOB FUNCTIONS include, but are not limited to:

1. Prepares and reviews all billing forms to ensure accuracy and completeness for claims submission to insurance carriers.

• Identifies and records required billing information according to insurance carrier requirements with 100% accuracy.
• Completes billing information accurately.
• Processes claims electronically with 100% accuracy and mails claims to insurance carriers daily.

2. Enters documentation and adjustments through computer system to maintain a correct account balance.

• Updates system information daily according to correspondence received and processed.
• Documents any changes on a daily basis and submits information to appropriate personnel.
• Seeks clear directions to resolve issues and bring problems to a proper resolution.

3. Reviews and identifies charge discrepancies and completes all requests for rebilling from inter-department personnel.

• Reviews charge summaries on each patient bill that is produced and identifies discrepancies with 100% accuracy.
• Audits requests for accurate information.
• Completes rebilling within 10 days according to established rebilling procedures.
• Manually documents rebilling log upon completion with 100% accuracy.

4. Prepares daily production reports, maintains required records, reports, and files while evaluating account information.

• Monitors number of accounts and outstanding balances within three days of receiving report.
• Consistently applies appropriate procedures to prevent accounts from becoming delinquent or remaining unbilled.
• Initiates appropriate follow-up.

5. Performs all other duties as assigned.

SPECIFIC EXPERIENCE REQUIREMENTS: Prior experience with general office responsibilities.

SPECIFIC EDUCATIONAL REQUIREMENTS: High School Diploma preferred.

SPECIAL SKILL, LICENSE AND KNOWLEDGE REQUIREMENTS: Minimum typing skills of 45 wpm, ten key by touch, data entry skills.

HIPAA REQUIREMENTS: Maintains knowledge of and adherence to all applicable HIPAA regulations appropriate to Job Position.

SAFETY REQUIREMENTS: Maintains knowledge of and adherence to all applicable safety practices appropriate to Job Position including but not limited to: incident reporting, handling wastes, sharps and linens, PPE, exposure control plan, hand washing, and environmental round to ensure safety.