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Company Name : Alaska Heart and Vascular Institute
Location : Anchorage, AK 99508
Position : Billing Specialist III
Job Description : Join a quality-focused, team-oriented, growing organization. Set in beautiful Anchorage, Alaska this is an in-office job working with a dynamic team in an environment that ensures the highest safety measure.
A robust benefits plan includes competitive pay, relocation/sign-on bonus, excellent benefits package including medical, dental, flexible spending accounts, life insurance, voluntary insurance, and vision coverage. PTO in addition to 8 paid holidays per year. And many other perks as part of an employee and patient satisfaction-centered environment.
JOB TITLE: Billing Specialist III
DEPARTMENT: Business Office
GENERAL SUMMARY OF DUTIES: Responsible for filing and tracking insurance claims for the assigned alpha split. Work Insurance and Patient Aging for complete resolution of accounts. Successfully receiving payment on all assigned claims through timely claim resolution, which includes: researching and resolving insurance claim disputes, providing corrected billing, and submitting appeals. Initiative to thoroughly understand all AHI services is strongly recommended.
SUPERVISON RECEIVED: Reports to Business Operations Director
SUPERVISION EXERCISED: None
TYPICAL PHYSICAL DEMANDS: Requires prolonged sitting, some bending, stooping and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Occasional stress from varying demands. Must be able to work independently. Must be able to lift/carry up to 25 pounds.
TYPICAL WORKING CONDITIONS: Work is performed in a busy office environment. Frequent contact with employees, patients, physicians and outside agencies. Occasional evening or weekend work.
ESSENTIAL FUNCTIONS:
Maintain strictest confidentiality.
Stay current with coding and billing guidelines for all and each payer, including but not limited to CMS, Noridian Medicare, VA, Triwest, Tricare, Aetna, Premera, Cigna and other third party payers
Understanding of all AHI services
Professional and HIPAA compliant interactions with patients, insurance companies, Alaska Heart & Vascular Institute (AHVI) providers and staff, outside healthcare professionals and other agencies
Must be able to successfully demonstrate the ability to perform all functions of a Billing Specialist I and II, in addition to the below:
EDI submission, with complete understanding of AHVI EDI processes
Work the clearinghouse rejections in prompt manner
Paper claim submission with appropriate EOBs and any other required paperwork
Complete and thorough research of all claims subject to insurance dispute or review
Complete and thorough research of each denied and rejected claim in prompt manner
Complete and thorough research of each and every aging claim in an account, to prevent any repeated trivial work
Consistent follow through of aging reports to ensure timely payment by payers
Complete and thorough review of EOB, payer policies, AHVI polices and processes for proper responses to payer requests and denials
Concise yet detailed and accurate notes in accounts and/or tickets for efficient communication with coworkers
Accurate information in accounts and tickets to maintain adequate audit trail
Timely working of denied and/or rejected claims
Timely submission and successful payment of appeals, or other requested documentation, by insurers for proper claim resolution and payment.
Diligent follow up of claims for complete resolution
Prepare patient refund requests, per AHVI policies and processes
Prepare insurance refund requests and recoupments, per AHVI policies and processes and payer specific requirements
Timely requests for refund, to be compliant with payer guidelines, including Medicare’s timely requirement
Utilize resources such as Clearwave and payer sites, including AIM and Comagine, for authorization issues, as appropriate
Identify patients’ financial status and arrange payment plans as needed, per AHVI policies and processes
Complete understanding of and adherence to AHVI financial assistance program policies and processes for delinquent accounts
Complete understanding of and adherence to AHVI collection policies and processes for delinquent accounts
Occasional court appearances as AHVI representative as requested by outside collection agency
Research mail returns for timely updates of account information
Maintain login access to programs, hospitals and payer sites
Utilize the resources at the payer sites consistently
Process patient statements, per AHVI policies and processes
Participate in educational activities, including webinars, newsletters, online training, etc.
Perform related work as required.
Perform other duties as assigned
PERFORMANCE REQUIREMENTS:
Knowledge, Skills, Abilities
Knowledge of collection techniques and regulatory provisions
Knowledge of bankruptcy regulations
Knowledge of computerized practice management systems
Knowledge of medical terminology
Knowledge of insurance company procedures
Knowledge of medical billing practices and procedures
Knowledge of insurance company procedures regarding reimbursements
Knowledge of EOB categories
Knowledge of accounts receivable practices and medical business office procedures
Knowledge of working an aging report
Knowledge of basic accounting
Knowledge of computerized software programs (Microsoft Word, Excel, Outlook)
Knowledge of basic medical coding
Knowledge of legal and regulatory government provisions
Skill in interpersonal relationships necessary to deal effectively and courteously with callers, patients and families, insurance companies, other agencies and AHVI personnel and providers.
Skill in gathering, analyzing and interpreting information; requires great attention to detail.
Skill in computer applications; Excel, Word, Outlook; requires excellent keyboarding skills.
Skill in exercising initiative, judgment and decision making to achieve department objectives.
Skill in ten key calculator use by touch.
Skill in oral and written communication.
Skill in time management and organization.
Ability to maintain strictest confidentiality of financial and personal matters relating to AHVI patients and AHVI business activities.
Ability to read, write and speak English.
Ability to communicate tactfully, courteously and effectively with patients, staff, and others.
Ability to work cooperatively with others in a team environment.
Ability to perform mathematical computations with the aid of a calculator.
Ability to be highly efficient, organized and accurate in all work.
Ability to handle stressful situations tactfully.
Ability to courteously answer incoming phone calls promptly.
Ability to understand and interpret policies and regulations.
Ability to examine documents for accuracy and completeness.
Ability to identify claim problems and recommend solutions.
Ability to sort and file materials correctly by alphabetic or numeric systems.
Ability to balance demands of position to meet departmental objectives.
Ability to accurately enter data and examine insurance documents.
Demonstrate ability to multi-task; perform tasks within time frames assigned.
Demonstrate schedule flexibility; adjust to shifting priorities; stay organized in a changing environment; stay focused during stressful or difficult situations; exhibit comfort with ambiguity.
Education:
Preferred: Some college or continuing education preferred.
Minimum: High School diploma
Experience:
Minimum: Two years of experience in medical billing office with emphasis on insurance research and claim follow-up
Certificate/License: Certified Professional Biller (CPB) or Certified Coder (CPC) required from AAPC
INTERPERSONAL COMMUNICATION REQUIREMENTS:
Commitment to the Alaska Heart and Vascular Institute standard for interaction with patients, visitors, physician offices, hospitals or agencies and coworkers is required. Employees of Alaska Heart and Vascular Institute will maintain a consistent standard of interaction with others as follows:
Demonstrates a professional, helpful and friendly attitude, which is directed toward and focused on providing quality patient care and satisfaction in a cooperative manner.
Maintains a professional and pleasant demeanor and appearance, which is reflective of a positive representation of the Alaska Heart and Vascular Institute.
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