Billing Specialist - Periop Admin - HPW - FT - Day

Work Shift:

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 advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made up of more than 250 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Position Overview:

Capital Health Job Descriptions VERSION: 2 JOB TITLE: Billing Specialist COST CENTER: 000000 JOB CODE: 50343 FLSA Exemption Status: Non-Exempt Telecommuting Eligible: SUMMARY (Basic Purpose of the Job) Supports department by providing multifaceted billing and insurance assistance. Assists with billing projects such as daily billing audits, daily electronic billing and obtaining documentation in instances when claims are denied, or questions. Obtains patient treatment or imaging pre-authorizations and develops a system to track this information daily. Performs billing functions, including coding, charging, and auditing, as the liaison within the department. Sequences codes accurately for proper and optimal DRG assignment. Queries physicians as needed to ensure proper assignment of codes. Abstracts data from the medical records and assures that all required elements are appropriately entered into the hospital information system. Helps the department in instances of resource reallocation as needed. Performs other duties as assigned. MINIMUM REQUIREMENTS Education: High school diploma or GED. Experience: Two years of medical insurance, insurance preauthorization, billing, or coding experience. Previous hospital billing experience preferred. Other Credentials: Knowledge and Skills: Intermediate experience with billing. Familiarity with insurance language. Basic understanding of coding preferred. Special Training: Basic computer skills. Understanding of ICD-9 and CPT coding classifications. Thorough knowledge of medical terminology, anatomy, and physiology. Mental, Behavioral and Emotional Abilities: Strong interpersonal skills. Able to interact with insurance companies and physicians. Works well in team settings. Excellent organizational skills. Excellent follow-up skills. Usual Work Day: 8 Hours Reporting Relationships Does this position formally supervise employees? No ESSENTIAL FUNCTIONS Reviews, updates, corrects, and approves daily all case charges from sites within the billing system. Enters all medical and hospital charges, and other facility charges into the billing system. Assures accuracy of these charges and poses them electronically. Verifies in billing System that all charges for supplies, rooms, and other medical expenditures and assures their correct and accurate entry for proper reimbursement. Runs daily reports for cases and documents to validate accurate charges. Collaborates daily with nurses to add, change, update charges or documentation. Assists in obtaining insurance pre-authorizations for patient consults, exams, treatments, imaging for patients being treated. Assists in follow-up process for pending authorizations by providing necessary answers to questions from others or clinical documentation. Develops spreadsheet to track pre-authorizations and treatment codes to ensure compliance with current treatment plan. Coordinates peer to peer authorization process when authorizations are denied. Obtains base prices as needed for specific charges and manually enters them into the billing system. Acts as a resource for the department on any issues related to coding and billing. Follows up daily with outside departments on any issues, clarification, questions, or updates to ensure billing accuracy. Verifies against final patient orders and other documentation that all supply charges have been received. Revises and corrects any billing discrepancies provided by the billing department. Works collaboratively with other departments for billing related issues, pricing, coding, billing, and recalls. Assigns codes with accuracy rate in accordance with coding guidelines. Applies special codes (charge post) to certain procedures (cap pricing) for correct billing. Manually charges post the cap price CDM for all required from a capped price agreement. Discusses medical record information with physicians when necessary in accordance with coding guidelines. Contacts physicians or other staff to obtain missing documentation or signatures timely. Assists Medical Records, Compliance, and Finance Departments with appeals process by providing necessary documentation. Tracks medical records requests from Patient Account Department billers and reviews to ensure compliance. Prepares and communicates to appropriate parties on medical records reports and overdue medical records for purpose of satisfying claims to increase revenue. Performs other duties as assigned. PHYSICAL DEMANDS AND WORK ENVIRONMENT Frequent physical demands include: Sitting , Wrist position deviation , Pinching/fine motor activities , Keyboard use/repetitive motion Occasional physical demands include: Standing , Walking , Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl Continuous physical demands include: Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 10 lbs. Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Color Discrimination, Minimal Depth Perception, Minimal Hearing Anticipated Occupational Exposure Risks Include the following: Dust/Particulate Matter

Offers are contingent upon successful completion of our onboarding process and pre-employment physical.  Capital Health will require all applicants to have an annual flu vaccine prior to start date, with the exception of individuals with medical and religious exemptions.