BILLING QA COMPLIANCE SPEC

Premier Health Partners; Moraine (OH); On-site; USD 52,000 - 66,000; Full time

Job summary

Premier Health Partners seeks a Patient Financial Services Specialist to review inpatient and outpatient accounts for billing and coding compliance, ensuring accurate documentation and appropriate charges. The role involves monitoring billing quality and following up on outstanding accounts in the billing queues.

With 3-5 years of revenue cycle experience, you should have strong Microsoft Office skills and knowledge of Medicare regulations related to charging and reimbursement.

Qualifications

• Must have 3-5 years of job-related experience.
• Knowledge of Medicare regulations related to charging and reimbursement preferred.
• Experience with hospital billing and follow-up preferred.
• Familiarity with medical terminology and DRG assignments is a plus.

Responsibilities

• Review inpatient and outpatient accounts for billing and coding compliance.
• Monitor quality of billing and review accounts for proper documentation to validate billing information.
• Handle follow-up on outstanding accounts in billing and follow-up work queues.
• Understand reimbursement aspects of the revenue cycle to ensure appropriate charges billed.
• Stay informed on governmental rules regarding chargeable versus payable and compliance claims.
• Monitor timely billing and follow-up of clinical trial accounts if applicable.

Skills

Microsoft Office

Training & Education

Education

High School Diploma / GED

Associate degree in Healthcare, Business Administration, Health Information Management

Job description

General Summary/Responsibilities

Under the general direction of the Supervisor Patient Financial Services this employee is responsible for the review of Inpatient and Outpatient accounts for billing and coding compliance for Patient Financial Services (PFS). He/she monitors for quality of billing, and reviews accounts for appropriate documentation to validate billing information. This employee is also responsible for follow up on outstanding assigned accounts in their billing and follow up work queues. All work is carried out in accordance with PFS approved policies and procedures. The specialist is also responsible for understanding reimbursement aspects of the revenue cycle and will work to ensure Premier Health receives the appropriate reimbursement for charges billed. The specialist is responsible for understanding governmental rules and regulations regarding chargeable verses payable, and the components of a compliance claim. Will monitor timely billing and follow-up of clinical trial accounts as a part of work queue audit reviews (if applicable to job duties).

Education

Minimum Level of Education Required: High School completion / GED

• Type of degree: High School Diploma with 3-5 years’ experience or Associate degree in Healthcare, Business Administration, Health Information Management

Experience

Minimum Level of Experience Required: 3 - 5 years of job related experience

Prior job title or occupational experience: Revenue Cycle Experience.

Prior specific functional responsibilities: Demonstrated working knowledge of Microsoft Office applications is required. Demonstrated ability to train and educate to all levels of the organization is required.

Preferred experience: Current knowledge of Medicare regulations as it relates to charging and reimbursement is highly preferred. Current knowledge of hospital billing and follow up is preferred. Knowledge of medical terminology knowledge of human pathology and diseases and how they relate to diagnosis and DRG assignments