Hospital Billing Representative

Company: Children's National Medical Center
Location: Silver Spring
Posted on: June 6, 2021

Job Description:

The Hospital Billing Specialist will be responsible to ensure hospital claims are complete, accurate and billed within the expected time frame according to internal billing policy, Federal and State regulations and Managed Care contract guidelines. Will be well-versed in HIP AA standards, NCCI coding and billing regulations for hospital service claims to include hospital, specialty and primary care based services. Will develop a detailed understanding of assigned managed care contractor and payor requirements. Will track and report billing trends with assigned carriers.

Minimum Education

High School Diploma or GED (Required)

Associate's Degree - Associates Degree / Healthcare Billing Vocational Training (Preferred)

Minimum Work Experience

2 years - Hospital billing or related education (Required)

5 years - Hospital billing, collections and coding (Preferred)

Required Skills/Knowledge

Analytical problem solver, detail oriented, efficient, and productivity driven.

Ability to process large volumes on a daily basis.

Computer Skills.

Accurate and Expediant Typing.

Web Search. Excel, Word.

Good communication skills both verbal and written.

Understanding of managed care contracts and insurance compliance.

Detail oriented with excellent organizational skills.

Fast paced - productivity driven with emphasis on quality.

Knowledge of hospital service billing / CPT/ ICD coding.

Functional Accountabilities

Queue Management

1. Monitor Claims Outstanding Report daily using various sorts to manage daily claim volumes and timelines according to policy.

2. Monitor claim errors by Form and report trends, new incidents, duplications, incorrect payer mix and unusual volumes.

Productivity

1. Research and take action on all failed claims to bill or pend on hold for additional information by the end of the import day.

2. Follow-up and resolve claims in Held status daily .

3. Bill secondary claims no less than twice a week - Maintain age less than 5 days from import.

4. 150 to 200 claims addressed per day contingent on assignment.

Quality

1. Coordinate supporting documents to ensure validity for services billed.

2. Audit claim details for standard claim data prior to submission to ensure accuracy and complete edit satisfaction.

3. Follow written procedure, payer policy , guidelines and edit instruction completely

4. Stay abreast of payer updates on at least a quarterly basis and shares changes with Leadership and Team.

Claim Corrections and Billing

1. Research coding errors using CPT and ICD guidelines, Craneware and NCCI tools, Medical Records and Account Systems. Following procedure pursue authorization for code corrections.

2. Apply data corrections to claim and/or host systems performing transaction updates/same claim or charge corrections/new claim as outlined in procedures.

3. Apply claim notes to provide detailed explanation to downstream users when claims are pending corrections (Held claim) or not billed (Archive/Del). Document the: (1) Problem, (2) Research, (2) Findings, (3) Action Taken, (4) FU plan

4. Coordinate submission of supporting documentation, e.g., treatment plans, operative reports, EOB.

Keywords: Children's National Medical Center, Silver Spring , Hospital Billing Representative, Other , Silver Spring, Maryland