Catholic Health Initiatives BILLING REP - CHI Health Pharmacy-Service Center in OMAHA, Nebraska

BILLING REP - CHI Health Pharmacy-Service Center

Description

Job Summary:

This position contributes to the mission of CHI Health be ensuring medical and pharmacy benefits are accurately billed, as well as management of patient and physician accounts receivable. This position works collaboratively with purchasing, patient care, ancillary, and pharmacy services. The position works in concert with additional pharmacy billing specialists to ensure appropriate and timely notices to patients as well as ensure accurate revenue reporting to pharmacy leadership. This position is integral to the overall success of the pharmacy service line and revenue integrity.

Essential Duties:

  1. Maintains appropriate documentation of outpatient billing practices.

  2. Maintains professional growth and development through assigned and optional seminars and workshops.

  3. Participation in the development and implementation of department policies and procedures.

  4. Communicates a professional attitude with other departments.

  5. Maintenance of required records, reports and statistics for administrative, regulatory, and budgetary purposes.

  6. Demonstrates work practices consistent with CHI Health and department specific safety, security policies.

  7. Must have ability to work effectively and collaboratively in a diverse and multi-cultural environment.

  8. Accounts Receivable processing, mailing, payment posting, document patient activity, and submission to collections when all other avenues are exhausted.

  9. Research insurance eligibility and coverage and benefits on patients and complete any necessary paperwork or submit clinical notes in a timely manner to ensure approval of claim(s).

  10. Complete any pre-authorizations required by insurance companies by communicating with clinical and hospital staff to procure any necessary clinical documentation needed to assure future claim approvals.

  11. Submit manual and electronic insurance claims to third party payers in a timely and accurate manner to ensure timely submission and accurate payment.

  12. Review claim error reports, identify errors and make necessary corrections to avoid denials.

  13. Post third party payments, apply contractual adjustments, bill patient for any copays/coinsurance, and/or submit secondary and tertiary claims to other coverage's.

  14. Follow up on pending/denied claims to ensure timely and accurate payment by payer and complete any appeals for Durable Medical Equipment claims.

  15. Review Medicare remittances to ensure submission, errors, and payments are correct in timely manner; submit all possible levels of appeals if needed.

Qualifications

Ability to utilize computer processing in day to day activities; strong knowledge of applicable laws, regulations, guidelines and professional standards; good communication skills; strong teamwork skills; must demonstrate personal traits of a high level of motivation; team orientation; professionalism; trust; and place a high value on treating others with dignity and respect. Proficient in Microsoft Office programs (Excel, Word, Outlook, etc). Knowledge of HCPCS/CPT/ICD-10 preferred. Knowledge of DME or professional HCFA billing, Accounts Receivable, and collections. Ability to perform non-complex mathematical calculations.

High school diploma or GED. A minimum of two years of medical billing experience preferably in a health care environment is desirable. Understanding of medical terminology, anatomy, physiology, disease processes, and pharmacology preferred. Pharmacy technician or revenue cycle experience preferred.

Job Pharmacy

Primary Location NEBRASKA-OMAHA-SERVICE CENTER-SOUTH BLDG

Daily Schedule Hours between 8am-4pm

Scheduled Hours per 2-week Pay Period 40

Weekends Required None

Req ID: 2017-R0116564