Healthcare Billing Specialist II
The Healthcare Billing Specialist position qualifies clinical and other documentation based on third party payers requirements. Acts as the liaison between internal and external customer, KCI, and third party payer to ensure the order meets regulatory and payer requirements. Obtain and analyze required documentation for clean billing of claims.
- Analyze and prioritize work list based on departmental inflows and to minimize pre-billing write offs.
- Quality check of initial order release to ensure third party payer and coverage criteria is met
- Verify third party payer benefits and eligibility for subsequent rental cycles (online or telephonically).
- Prepares clean claim for billing.
- Review and analyze payer specific requirements and coverage criteria to determine required documentation and Customer accurate billing criteria.
- Conduct in depth review of clinical documentation (medical records, prescriptions, operative reports, history and physicals) based on billing criteria.
- Call customer or field personnel to obtain missing documentation required for billing. Could include home health agencies, patients, hospital/facilities, physicians.
- Build support and maintain patient, physician, and third party payer loyalty and to increase the number of orders through enhanced customer services, customer relationship management, and technology utilization.
- Provides a high level of customer service in a competitive market.
- Acts as a resource for Sales and other cross functional departments to provide billing status and any other information.
- Participates in any and all reasonable work activities as may be deemed suitable and assigned by management.
- Conforms to, supports and enforces all Company policies and procedures.
- High School Diploma or equivalent.
- 1 -3 year of previous supervisory experience
- Experience with Microsoft Office applications including: Word, Excel, Outlook.
OTHER REQUIRED QUALIFICATIONS
In addition to the basic qualifications listed above, the following other position qualifications are required:
- Demonstrated ability to interact with all employees and external business contacts while conveying a positive, service-oriented attitude.
- Demonstrated problem-solving skills.
- Demonstrated ability to work in a team environment, as well as, independently.
- Ability to multi-task and adapt in a fast paced and changing environment
- Demonstrated ability to maintain confidentiality and discretion in business relationships and exercise sound business judgment.
- Ability to communicate effectively both verbally and in writing.
- Satisfactory completion of all training programs.
In addition to the basic qualifications and other required qualifications listed above, the following preferred qualifications also exist:
- Two or more years of related healthcare experience.
- Call Center experience
- Some college course work completed