Responsible for performing billing, collections and reimbursement services of claims and duties to hospitals supported by the RCBS. In doing so, ensures that all claims billed and collected meets all government mandated procedures for Integrity and Compliance. Performs billing, collections and reimbursement services in a prompt and efficient manner. Provides thorough, courteous and professional assistance to patients, physician offices, insurance companies and other clients on an as needed basis while maintaining strictest confidence. Documents, forwards, resolves incoming mail and correspondence. Demonstrates a level of accountability to ensure data and codes are not changed on claims prior to submission if related to diagnosis, charge and/or other clinical type data that RCBS would not have knowledge of. Ensures all Compliance errors are reported to the Director and maintain records and files of documentation supporting bill changes that are directed by Director and/or Integrity Officer. Responsible to ensure successful implementation of Governmental Regulatory Billing changes, including but not limited to Medicare OPPS effective August 1, 2000.

A. Experience:

• Must have minimum of 2 years experience in any of the following: Medicare, Medicaid and/or Commercial Insurance billing, collections, payment and reimbursement verification and/or refunds.
• Understanding of alternative Business Office financial resources and the ability to provide information and/or recommendations related to these sources of recovery are preferred.
• General hospital A/R accounts knowledge is required.
• College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.

B. Education and Training:

• HS Diploma or equivalency required
• Post HS education preferred

C. Skills:

• Must have good verbal and written communication skills in order to present and explain information to internal and external customers.
• Ability to write letters.
• Must have practical experience with Word, Excel, Adobe applications.
• Must have ability to make independent decisions that are generally guided by established procedures.
• Must have a desire to learn ethical and compliant business practices.
• Must be able to handle sensitive, stressful and confidential situations and account information.
• Must have excellent keyboarding and 10-key skill-set.
• Must have knowledge to perform functions requiring the use of the internet.
• Willingness and ability to learn new tasks.
• Experience with the Medicare billing process -- what claims can be rebilled online vs doing a redetermination
• Understanding of Medicare language
• At least five years of experience billing, collecting and validating Medicare payment
• Understanding of how and when to bill Medicare as secondary
• Understanding of Medicare Dialysis billing
• How to read the information in the Common Working File -- HMO coverage, Hospice dates, COB screens etc.
• Hand's on experience with Medicare Remote -- DDE
• Understanding of and exposure to Medicare Recovery Audit Contractor
• Hand's on experience with working Medicare Status Locations (ex: RTP, Denied, Suspense)
• Experience with compiling both Redeterminations and Reopening's of Medicare claims
• Knowledgeable in locating and referencing CMS and/or Medicare Regulations

D. Licenses, Registrations, or Certifications:

• None required