Billing Coordinator

Responsibilities

PRIMARY FUNCTION:

This position will be responsible for the management of all complex billing, analysis, and revenue/billing for the Department of Pulmonary and Allergy technical and professional billing across TJUH, Aria and other JUP locations. Incumbent will ensure all federal regulations and policy & procedures are adhered to with respect to auditing, billing, coding, & documentation of compliant medical necessity. In-depth knowledge of clinical operations and front-end patient registration is required. This position will review, audit and recommend revisions to department billing policy and procedures as needed.

Hours: Mon- Wed: 8a-5p & Thurs-Fri: 7:45a-4:45p

Essential Functions

• Ensures accurate and timely billing of all hospital and professional charges, reviews all billing to ensure that charges are consistent with medical necessity documentation; services are rendered and meet all compliance requirements.
• Works with physicians and staff to obtain information required for initial claim submission, and for follow-up to edits, denials and rejections while managing the charge capture process and quality assurance in working with the Pulmonary and Allergy team.
• Obtains prior authorizations for procedures when needed.
• Manages billing denials. Follows up on each denial to determine if the cause was physician related, system related, or billing error. Eliminate the causes of denials and collect the maximum on each patient account as rapidly as possible.
• Ensures all diagnosis and procedures that may impact the facility’s reimbursement are identified based on accepted diagnostic coding guidelines attested to by the physician, sequenced correctly and coded in an accurate and ethical manner for optimum reimbursement.
• Consults with physicians and nurse managers for clarification of clinical data when encountering conflicting or ambiguous information and/or missing documentation.
• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson
  
  

Other Functions And Competencies

• Process billing of daily code captures. Includes coordination of the daily operations and workflow processes while managing billing edits/denials.
• Responsible for working Quality Assurance Check Lists implemented by Physics and Dosimetry staff to insure the accurate collection and capture of charges.
• Adjust work assignments as necessary to keep billing lag to a minimum.
• Daily Charge reconciliation.
• Keep up-to date with Mosaiq /EMR system upgrades that affect workflows related to billing and documentation.
• Respond to telephone inquiries from patients and insurance companies regarding billing, coverage criteria, coordination of benefits and subscriber eligibility.
• Assist Director with monthly Collection Report.
• Assist Director with developing and implementing procedures to streamline billing process and improve efficiency of process.
• Scheduling and answering phone calls.
• Cover other positions within the department when needed.
  
  

Qualifications

• High School diploma or GED required. Associates degree preferred
• 5 or more years of experience in billing operations
• Word, excel, NaviNet, EviCore etc. Must have knowledge of CPT and ICD-10 coding. Up-to-date knowledge of third-party rules and regulations. Knowledge of medical terminology