JOB PURPOSE OR MISSION: To review and prepare billing forms and ensure accuracy and completeness for electronic or hardcopy claims submission.
PERFORMANCE CRITERIA
CRITERIA A: Everyday Excellence Values - Employee demonstrates Everyday Excellence values in the day-to-day performance of their job.
PERFORMANCE STANDARDS:
- Demonstrates courtesy and caring to each other, patients and their families, physicians, and the community.
- Takes initiative in living our Everyday Excellence values and vital signs.
- Takes initiative in identifying customer needs before the customer asks.
- Participates in teamwork willingly and with enthusiasm.
- Demonstrates respect for the dignity and privacy needs of customers through personal action and attention to the environment of care.
- Keeps customers informed, answers customer questions and anticipates information needs of customers.
CRITERIA B: Corporate Compliance - Employee demonstrates commitment to the Code of Conduct, Conflict of Interest Guidelines, and the GHS Corporate Compliance Guidelines.
PERFORMANCE STANDARDS:
- Practices diligence in fulfilling the regulatory and legal requirements of the position and department.
- Maintains accurate and reliable patient/organizational records.
- Maintains professional relationships with appropriate officials; communicates honestly and completely; behaves in a fair and nondiscriminatory manner in all professional contacts.
CRITERIA C: Personal Achievement - Employee demonstrates initiative in achieving work goals and meeting personal objectives.
PERFORMANCE STANDARDS:
- Uses accepted procedures and practices to complete assignments. Uses creative and proactive solutions to achieve objectives even when workload and demands are high.
- Adheres to high moral principles of honesty, loyalty, sincerity, and fairness.
- Upholds the ethical standards of the organization.
CRITERIA D: Performance Improvement - Employee actively participates in Performance Improvement activities and incorporates quality improvement standards in his/her job performance.
PERFORMANCE STANDARDS:
- Optimizes talents, skills, and abilities in achieving excellence in meeting and exceeding customer expectations.
- Initiates or redesigns to continuously improve work processes.
- Contributes ideas and suggestions to improve approaches to work processes.
- Willingly participates in organization and/or department quality initiatives.
CRITERIA E: Cost Management - Employee demonstrates effective cost management practices.
PERFORMANCE STANDARDS:
- Effectively manages time and resources.
- Makes conscious effort to effectively utilize the resources of the organization — material, human, and financial.
- Consistently looks for and uses resource saving processes.
CRITERIA F: Patient & Employee Safety - Employee actively participates in and demonstrates effective patient and employee safety practices.
PERFORMANCE STANDARDS:
- Effectively communicates, demonstrates, coordinates and emphasizes patient and employee safety.
- Proactively reports errors, potential errors, injuries or potential injuries.
- Demonstrates departmental specific patient and employee safety standards at all times.
- Demonstrates the use of proper safety techniques, equipment and devices and follows safety policies, procedures and plans.
JOB FUNCTIONS
ESSENTIAL JOB FUNCTIONS include, but are not limited to:
1. Prepares and reviews all billing forms to ensure accuracy and completeness for claims submission to insurance carriers.
PERFORMANCE STANDARDS:
- Identifies and records required billing information according to insurance carrier requirements with 100% accuracy.
- Completes billing information accurately.
- Processes claims electronically with 100% accuracy and mails claims to insurance carriers daily.
2. Enters documentation and adjustments through computer system to maintain a correct account balance.
PERFORMANCE STANDARDS:
- Updates system information daily according to correspondence received and processed.
- Documents any changes on a daily basis and submits information to appropriate personnel.
- Seeks clear directions to resolve issues and brings problems to a proper resolution.
3. Reviews and identifies charge discrepancies and completes all requests for rebilling from inter-department personnel.
PERFORMANCE STANDARDS:
- Reviews charge summaries on each patient bill that is produced and identifies discrepancies with 100% accuracy.
- Audits requests for accurate information.
- Completes rebilling within 10 days according to established rebilling procedures.
- Manually documents rebilling log upon completion with 100% accuracy.
4. Prepares daily production reports, maintains required records, reports, and files while evaluating account information.
PERFORMANCE STANDARDS:
- Monitors number of accounts and outstanding balances within three days of receiving report.
- Consistently applies appropriate procedures to prevent accounts from becoming delinquent or remaining unbilled.
- Initiates appropriate follow-up.
5. Performs all other duties as assigned.
SPECIFIC EXPERIENCE REQUIREMENTS
Prior experience with general office responsibilities.
SPECIFIC EDUCATIONAL REQUIREMENTS
High School Diploma preferred.
SPECIAL SKILL, LICENSE AND KNOWLEDGE REQUIREMENTS
Minimum typing skills of 45 wpm, ten key by touch, data entry skills.
HIPAA REQUIREMENTS:
Maintains knowledge of and adherence to all applicable HIPAA regulations appropriate to Job Position.
SAFETY REQUIREMENTS:
Maintains knowledge of and adherence to all applicable safety practices appropriate to Job Position including but not limited to: incident reporting, handling wastes, sharps and linens, PPE, exposure control plan, hand washing, and environmental round to ensure safety.
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