Under general supervision, ensures that hospital charges are accurate and appropriate to maximize hospital recoveries, maintain compliant charging practices and patient relations.
Education:
Bachelors Degree in nursing
Licensure:
RN
Experience:
3 yrs of related experience in medical billing
Skills:
* Knowledge of the International Classification of Diseases and CPT coding system.
* Knowledge of medical terminology
* Skills in written and oral communication
* Advanced skill in using database software and personal productivity applications
* Ability to interpret medical terminology and decipher physicians' handwriting
* Ability to understand interfaces between computerized data collection, scheduling and patient accounting systems.
Patient & Workplace Safety:
Employee has knowledge and understanding of patient and workforce safety as it relates to job duties.
Patient Population:
Demonstrates competency in the delivery of care and applies the knowledge to meet age-specific needs if applicable.
Principal Duties and Responsibilities:
* Researches and corrects complex clinical charge errors. Identifies negative trends and elevates issues to all parties responsible for resolution.
* Resolves patient complaints related to charge issues. Determines services rendered from research of medical records and provides explanation of patient charges. Assists patients with proper interpretation of bill. Identifies inappropriate billing.
* Reviews late charge report and daily trends audit. Communicates errors and process issues to Finance and all parties responsible to avoid incorrect billing and late charges.
* Provides patients with price estimates for unique or complex inpatient procedures. Ensures unusual or more complex cases are coded correctly.
* Reviews denials from Insurance Carriers. Educates patients on the codes used and/or determines correct codes. Determines if account requires doctor's order to make changes where appropriate.
* Appeals technical and clinical denials based on information obtained from registration/insurance verification notes and medical records. Follows-up on appeals until resolved. Tracks and trends denials until resolved.
* Reviews RTP from Medicare daily to ensure appropriate coding and to review denials.
* Assists ROI Collection Agency with billing concerns and missed diagnoses to recover bad debt.
* Identifies and communicates issues with the Billing Compliance Committee. Represent Patient Accounting in Billing Compliance Committee meetings.
All roles must demonstrate GBMC Values:
Respect
I will treat everyone with courtesy. I will foster a healing environment.
Treats others with fairness, kindness, and respect for personal dignity and privacy.
Listens and responds appropriately to others' needs, feelings, and capabilities.
Excellence
I will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others.
Meets and/or exceeds customer expectations.
Actively pursues learning and self-development.
Pays attention to detail; follows through.
Accountability
I will be professional in the way I act, look and speak. I will take ownership to solve problems.
Sets a positive, professional example for others.
Takes ownership of problems and does what is needed to solve them.
Appropriately plans and utilizes required resources for various job duties.
Reports to work regularly and on time.
Teamwork
I will be engaged and collaborative. I will keep people informed.
Works cooperatively and collaboratively with others for the success of the team.
Addresses and resolves conflict in a positive way.
Seeks out the ideas of others to reach the best solutions.
Acknowledges and celebrates the contribution of others.
Ethical Behavior
I will always act with honesty and integrity. I will protect the patient.
Demonstrates honesty, integrity and good judgment.
Respects the cultural, psychosocial, and spiritual needs of patients/families/coworkers.
Results
I will set goals and measure outcomes that support organizational goals. I will give and accept help to achieve goals.
Embraces change and improvement in the work environment.
Continuously seeks to improve the quality of products/services.
Displays flexibility in dealing with new situations or obstacles.
Achieves results on time by focusing on priorities and manages time efficiently.
Pay Range
$25.88 - $42.44Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.
COVID-19 Vaccination
All applicants must be fully vaccinated against Covid-19 or obtain a GBMC approved medical or religious exemption prior to starting employment at GBMC Healthcare, to include Gilchrist and GBMC Health Partners.
Equal Employment Opportunity
GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.