Ambulatory Claim Editor Job at Tift Regional Health System in Tifton

DEPARTMENT : PATIENT FINANCIAL SERVICES

FACILITY : Medical Office Building

WORK TYPE : Full Time

SHIFT : Daytime

SUMMARY :

The Ambulatory Claims Editor is responsible for billing insurance companies and assuring billing guidelines remain current for all billing within their area of responsibility. Operates a personal computer system, multiple line telephone and performs miscellaneous clerical duties. Performs other work associated with the billing process.

RESPONSIBILITIES :

• Prepares and submits claims within their area of responsibility to third party insurance carriers either electronically or by hard copy billing.
• Keeps updated on all third party billing requirements and changes for insurance types within their area of responsibility and communicates with PFS follow-up and other billing staff.
• Secures needed medical documentation required or requested by third party insurances.
• Processes claim rejections related billing errors or late charges / credits by resubmitting claims to third party insurance carriers.
• Works with HIM and auditing staff to ensure that correct diagnosis / procedures are reported to third party insurance carriers.
• Monitors claims for missing information, authorization / control numbers.
• Completes work within authorized time to assure compliance with departmental standards.
• Verifies bridge routines are updated in EPremis and working properly.
• Corrects errors when a payer returns claims and re-submits claims to the payer.
• Checks status of accounts on hold and determines whether to keep on hold or release daily.
• Sends applicable medical records and invoices as appropriate for the claim.
• Checks accounts for secondary insurance after primary payer has sent remittance and adjusts balances accordingly.
• Verifies claims are received by the payer.
• Ensures precerts, ABNs, and documentation is submitted as appropriate.
• Documents all activity in computer in order to meet time filing limits.
• Keys all follow up activity into computer on each account.
• Assists staff in the department on rules and regulations of the payers.
• Answers questions from patients or guarantors regarding insurance status.
• Researches patient accounts for information requested by management.
• Keeps abreast of pertinent federal, and state regulations and laws and Tift Regional Health System, Inc. ("TRHS") policies as they presently exist and as they change or are modified.
• Understands and adheres to : TRHS' compliance standards as they appear in TRHS's Corporate Compliance Policy, Code of Conduct and Conflict of Interest Policy; and HIPAA and TRHS policies regarding privacy and security of protected health information.
• Demonstrates the ability to perform tasks that meet the age-specific requirements of the persons, patients, vendors, and staff that the employee is charged to interact with as required by the position.
• Offers suggestions on ways to improve operations of department and reduce costs.
• Attends all mandatory education programs.
• Improves self-knowledge through voluntarily attending continuing education / certification classes.
• Maintains required competency levels as identified in written exams, skills checklists, skills labs, annual safety and health requirements as well as service excellence education hours requirements.
• Cross-trains in order to better assist co-workers and to provide maximum efficiency in the department.
• Volunteers / participates on hospital committees, functions, and department projects.
• Manages resources effectively.
• Reports equipment in need of repair in order to extend life of equipment and removes malfunctioning equipment out of service with timely reporting to the appropriate personnel.
• Makes good use of time so as to not create needless overtime.

EDUCATION :

CREDENTIALS : OTHER INFORMATION :

Post high school courses in insurance billing, data processing and medical terminology preferred. One (1) year of experience in billing of third party insurances for facility and professional services required.

Southwell / Tift Regional Health System, Inc. is an Equal Opportunity Employer.