|Department : Eastern Division
Reports To: Manager
FLSA Status: Non-Exempt
Date: December 2011, February 2012
High school diploma or equivalent required and
One year of medical billing experience required or training or
Certification required, which must be obtained within 12 months from hire date, as follows:
- Certification as Certified Procedural Coder (CPC),
- Certification as Certified Coding Specialist--Physician-based, (CCS-P), or
- Certification as Registered Health Information Technician (RHIT, formerly Accredited Records Technician (ART))
Continued employment is contingent upon maintaining certification.
Knowledge of anatomy, physiology and medical terminology required. Working knowledge of federal and state laws and third party payor guidelines pertaining to medical billing required. Strong knowledge of Medicare billing regulations, general coding guidelines and UHA's Compliance Policy preferred.
One year experience in medical billing required. One year of additional work experience preferred. Previous clinical experience, as an LPN or Medical Assistant, highly desirable and will substitute for coding experience. Previous medical office experience preferred.
Performs billing functions in accordance with billing standards set forth in UHA Compliance Policy, with insurance regulations and coding guidelines. May act as liaison between front-end and back-end billing processes. Ensures accuracy and timeliness of departmental inpatient and outpatient billing. Analyzes and resolves issues of missing charges and problem accounts by researching information regarding department reimbursement. Provides feedback to faculty and residents concerning billing procedures and practices. Reviews medical records and assigns diagnosis and procedure codes. Maintains strong understanding of billing regulations of third party payors and state and federal agencies.
Essential Duties and Responsibilities include the following. Other duties may be assigned:
*A. Abstracts and may prepare fee slips for services rendered according to standards set forth in the UHA Compliance Policy and with insurance regulations. Assures accurate and timely coding occurs for appropriate payors. 60%
- Verifies accuracy of information by identifying patient name and medical record number to ensure proper medical record is processed. May request insurance information through Patient Services Representatives.
- May review medical record and assigns diagnosis and procedure codes for services rendered.
- May review fee slip by reading all pertinent data identifying missing and/or incomplete information. Determines deficiencies and notifies party responsible for correcting deficiencies. May transfer coded billing data from face sheet to fee slip. Enters information for all discharges.
- Monitors and completes backlog for area of responsibility.
*B. Monitors daily charges of providers by comparing completed fee slip to IDX schedule or by some other daily charge report tracking system. Ensures fee slip is complete for all services provided following UHA Compliance Policy standards and coding guidelines. 2%
C. May batch fee slips and enter charges. Ensures accuracy of data entered. 10%
- Batches fee slips by grouping slips by providers, and inpatient and outpatient services.
- Prepares batch ticket and totals charges for the batch.
- Enters batch and compares IDX system total with batch ticket total to ensure all charges have been entered.
D. May supervise departmental billing staff. 8%
- May include distribution of work, monitoring quality of work, keeping staff informed of policy and procedure changes. May also include hiring, evaluating, disciplining and termination of employees.
- May train billing staff concerning UHA billing process and procedures.
E. May verify inpatient billing information and enter into IDX system, as needed. 3%
- May obtain insurance verification and information from inpatient hospital business officer.
- May change financial status classification on IDX system when necessary.
- May establish payment plan, when necessary, for deductibles and co-payments and non-covered health care services according to established UHA policies and procedures and various insurance regulations.
F. Reviews daily charge report (i.e., Missing Charge Report), as needed. Researches to determine reason for fee slip not being generated. Prepares fee slip for services provided using medical record and following UHA Compliance Policy standards and coding guidelines. 2%
*G. Provides assistance to Department of Billing, Collections and A/R in claim development function to resolve problem patient accounts. 5%
- Reviews memos from Billing, Collections and A/R and provides corrected and/or additional information to resolve problem accounts.
- Researches medical record and prepares corrected fee slip following UHA Compliance Policy and coding guidelines.
- Communicates with insurance companies regarding problem accounts. Information provided may deal with pre-certification, pre-existing conditions, referrals, requests for chart notes and/or op notes. Communication may be by telephone or correspondence. Provides information in a timely fashion.
- May interact with patients regarding billing questions. Assists patients in completing insurance forms.
- Communicates with faculty and residents regarding billing questions.
*H. Assists with special reimbursement projects through review of payment analysis report. 3%
- Researches billing information and analyzes results.
- Performs various searches of information to aid both department reimbursement and physician research.
- Researches account receivable problems from third party payors.
- Reviews and updates codes on department fee slip on annual basis.
- Analyzes claims rejections by carriers to improve and correct reimbursement.
*I. Provides information and training to faculty and residents regarding coding procedures and practices by following UHA Compliance Policy standards and coding guidelines. 3%
- Acts as resource person regarding billing and coding procedure questions.
- Facilitates open communication in order to ensure accurate billing occurs.
*J. Coordinates billing for special medical programs, on an as needed basis. 2%
- Provides financial counseling and assistance to patients regarding special medical programs.
- Enrolls patients in special medical programs. Assists patients in completing insurance forms and consent forms.
- Contacts various insurance carriers related to program.
- Prepares all billing aspects for special program, including preparing fee slip following UHA Compliance Policy standards and insurance regulations. Forwards completed fee slip to Special Billing Unit of the Department of Billing, Collections and A/R.
- Prepares statistical reports, as needed.
*K. Maintains and enhances current knowledge of billing and coding practices and procedures through UHA quality reviews, attendance at meetings and seminars, study of reference material and updates to coding manuals. 2%
- Reviews newsletters, notices and updates to coding manuals to determine applicable billing and coding practices and procedures.
- Attends meetings, conferences and seminars, as approved by department, to remain updated.
- Attends mandatory educational training session covering UHA Compliance Policy guidelines on an annual/regular basis.
- Work will be reviewed to determine areas of deficiency and improvement.
Adheres to the established Performance Expectations for WVUH Employees in the areas of People, Service, Performance Improvement, and Shared Values & Culture.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Visual effort required in reviewing medical records and discerning physician handwritten information, and in viewing computer screens. Requires physical mobility to go to various clinical sites or to medical record departments. Manual dexterity required in operating computer and office equipment. Long periods of sitting to review medical records and to view computer screen. Lifting, stooping and bending are necessary in order to retrieve patient medical records of approximately 10 pounds or less.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Normal work environment
West Virginia University Hospitals Application