BILLING QA COMPLIANCE SPEC

General Summary/Responsibilities:

Under the general direction of the Supervisor Patient Financial Services this employee is responsible for the review of Inpatient and Outpatient accounts for billing and coding compliance for Patient Financial Services (PFS). He/she monitors for quality of billing, and reviews accounts for appropriate documentation to validate billing information. This employee is also responsible for follow up on outstanding assigned accounts in their billing and follow up work queues. All work is carried out in accordance with PFS approved policies and procedures. The specialist is also responsible for understanding reimbursement aspects of the revenue cycle and will work to ensure Premier Health receives the appropriate reimbursement for charges billed. The specialist is responsible for understanding governmental rules and regulations regarding chargeable verses payable, and the components of a compliance claim. Will monitor timely billing and follow-up of clinical trial accounts as a part of work queue audit reviews (if applicable to job duties).

Under the general direction of the Supervisor Patient Financial Services this employee is responsible for the review of Inpatient and Outpatient accounts for billing and coding compliance for Patient Financial Services (PFS). He/she monitors for quality of billing, and reviews accounts for appropriate documentation to validate billing information. This employee is also responsible for follow up on outstanding assigned accounts in their billing and follow up work queues. All work is carried out in accordance with PFS approved policies and procedures. The specialist is also responsible for understanding reimbursement aspects of the revenue cycle and will work to ensure Premier Health receives the appropriate reimbursement for charges billed. The specialist is responsible for understanding governmental rules and regulations regarding chargeable verses payable, and the components of a compliance claim. Will monitor timely billing and follow-up of clinical trial accounts as a part of work queue audit reviews (if applicable to job duties).

Under the general direction of the Supervisor Patient Financial Services this employee is responsible for the review of Inpatient and Outpatient accounts for billing and coding compliance for Patient Financial Services (PFS). He/she monitors for quality of billing, and reviews accounts for appropriate documentation to validate billing information. This employee is also responsible for follow up on outstanding assigned accounts in their billing and follow up work queues. All work is carried out in accordance with PFS approved policies and procedures. The specialist is also responsible for understanding reimbursement aspects of the revenue cycle and will work to ensure Premier Health receives the appropriate reimbursement for charges billed. The specialist is responsible for understanding governmental rules and regulations regarding chargeable verses payable, and the components of a compliance claim. Will monitor timely billing and follow-up of clinical trial accounts as a part of work queue audit reviews (if applicable to job duties).

Education

Minimum Level of Education Required: High School completion / GEDHigh School/GEDHigh School completion / GED

Additional requirements:

§ Type of degree: High School Diploma with 3-5 years' experience or Associate degree in Healthcare, Business Administration, Health Information Management High School Diploma with 3-5 years' experience or Associate degree in Healthcare, Business Administration, Health Information ManagementN/A

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Experience

Minimum Level of Experience Required: 3 - 5 years of job related experience3 - 5 years of job related experience

Prior job title or occupational experience: Revenue Cycle ExperienceRevenue Cycle Experience.

Prior specific functional responsibilities: Demonstrated working knowledge of Microsoft Office applications is required. Demonstrated ability to train and educate to all levels of the organization is required Demonstrated working knowledge of Microsoft Office applications is required. Demonstrated ability to train and educate to all levels of the organization is required.

Preferred experience: Current knowledge of Medicare regulations as it relates to charging and reimbursement is highly preferred. Current knowledge of hospital billing and follow up is preferred. Knowledge of medical terminology knowledge of human pathology and diseases and how they relate to diagnosis and DRG assignments

Knowledge/Skills

Current knowledge of Medicare regulations as it relates to charging and reimbursement is highly preferred. Current knowledge of hospital billing and follow up is preferred. Knowledge of medical terminology knowledge of human pathology and diseases and how they relate to diagnosis and DRG assignmentsCurrent knowledge of Medicare regulations as it relates to charging and reimbursement is highly preferred. Current knowledge of hospital billing and follow up is preferred. Knowledge of medical terminology knowledge of human pathology and diseases and how they relate to diagnosis and DRG assignments

• Strong written and oral communication skills required
• Ability to research and evaluate information
• Understanding of how to manage both clinical and financial data elements
• Strong interpersonal skills necessary to interact with all departments
• Ability to work and contribute to a team environment
• Ability to promote a positive work environment. Good interpersonal skills.
• Strong organizational skills. Ability to prioritize and coordinate multiple workflows simultaneously
• Detail oriented.
• Familiarity with Microsoft Office including Word and Excel are required.
• Basic knowledge of accounting principles, including debits and credits required.
• Ability to review work for detailed accuracy and completeness required.
• Basic math skills including percentages required.
• Medical terminology preferred.
• Detail oriented- pays close attention to detail.
• Customer Focus (15): is dedicated to meeting the expectations and requirements of internal and external customers; gets first-hand customer information and uses it for improvements in products and services; acts with customers in mind; establishes and maintains effective relationships with customers and gains their trust and respect.
• Integrity and Trust (29): is widely trusted; is seen as a direct, truthful individual; can present the unvarnished truth in an appropriate and helpful manner; keeps confidences; admits mistakes; doesn't misrepresent him/herself for personal gain.
• Dealing with Ambiguity (2): can effectively cope with change; can shift gears comfortably; can decide and act without having the total picture; isn't upset when things are up in the air; doesn't have to finish things before moving on; can comfortably handle risk and uncertainty.
• Interpersonal Savvy: relates well to all kinds of people, up, down, and sideways, inside and outside the organization; builds appropriate rapport; builds constructive and effective relationships; uses diplomacy and tact; can diffuse even high-tension situations comfortably.
• Time Management: uses his/her time effectively and efficiently; values time; concentrates his/her efforts on the more important priorities; gets more done in less time than others; can attend to a broader range of activities.
• Composure: must be able to stay steady under pressure.

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