Prepares and forwards patient claims to appropriate third-party payers. Analyzes and reviews claims to ensure that payer-specific billing requirements are met. Follows up on billing, determines and applies appropriate adjustments, answers inquiries and updates accounts as necessary.
Compile and prepare patient charges. Prepare invoices billings, UB-04 and 1500 claim forms to be sent to 3rd party payers for payment indicating individual line items for services and total costs. Review charges. Obtain and evaluate family, third party payers and agency resources for payment of charges. Managing patient billing and ensure procedures are billed according to contracts, transmit or mail all paper and claims, and review correspondence and follow up as needed.
May perform duties of FSR I & II. May have specialized areas of responsibility (e.g. government & non-government billing, appeal processing, review & approval of refunds, etc.).
Identify system and technology needs. Participate in advancing use of technology. Ensures systems meet all regulatory and compliance requirements.
Act as a preceptor and/or lead for new employees. Perform specialty services functions. Act as a resource within the department/division. Provide instruction for performing non-routine functions. Serve as a liaison between Physicians Billing Service, Admitting, Outpatient Surgery, Outpatient Department, Patent Financial Services and other Cincinnati Children's departments. May have supervisory responsibilities.
May perform research and analysis. Participate in departmental/division performance improvement and quality assurance controls. May develop and execute corrective actions plans.