Biller

Schedule: 8:30AM-5PM Mon-Fri.

1. Monitors and maintains billing filing system for in-house folders.

2. Review patient bills for accuracy and completeness and obtain any missing information

3. Knowledge of insurance guidelines, including HMO/PPO, Medicare, and state Medicaid and MCO’s

4. Check each insurance payment for accuracy and compliance with contract discount

5. Secures that all inpatient MCO/HMO are billed with authorizations.

6. Secures that all claims have correct Revenue Codes prior to billing

7. Identify and bill secondary or tertiary insurances

8. Knowledge of shadow billing. (Medicare replacement plans)

9. Knowledge of Medicare billing via FSS0

10. Transmit all final billed claims to clearinghouse.

11. Secures that all claims have been scrub for errors.

12. Secures that all modifiers are on the claims prior to billing.

13. Reconciles all claims by payor to secure that all claims are billed.

14. Reports to Director any billing issues timely.

15. Audits and corrects/modifies patient charges on current billings; monitors and corrects outpatient billing exception report.

16. Completes registration, charging and input of diagnosis for all outpatient Mental Health Accounts; inputs all charges for outpatient

Addiction Center Program.

17. Adds all ancillary outside service billings to the proper accounts; reviews and corrects all late charges; reviews all billings for DMH

funding.

18. Follows all hospital and departmental policies and procedures.

19. Completes appropriate volume of work while maintaining quality standards. Organize work procedures to generate acceptable

levels of productivity.

20. Maintains productivity reports and submits to Director on a weekly basis.

21. Assists Business Office staff personnel with billing and collection situations requiring special handling.

22. Performs other related duties as assigned.

COMPLIANCE RESPONSIBILITIES

• Understands and adheres to Loretto Hospital’s compliance standards as they appear in the Compliance Policy, Code

of Conduct and Conflict of Interest Policy.

• Keeps abreast of all pertinent federal, state and Hospital regulations, laws, and policies as they presently exist and as

they change or are modified.

• Ensures that the staff are trained and evaluated on their knowledge of and adherence to compliance policies and

procedures specific to their jobs.