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GENERAL APPLICATION INFORMATION: Rochelle Community Hospital is an Equal Opportunity Employer. All qualified applicants will be considered without regard to race, color, religion, gender, national origin, sexual orientation, age, marital status, medical condition, disability, protected veteran status, or any other legally protected status. All offers are contingent upon successful passing of a post-offer substance testing, positive reference checks and background check and your ability to establish your employment eligibility in the United States.
ALL RESUMES AND APPLICATIONS NEED TO BE SUBMITTED THROUGH
ILLINOISJOBNETWORK.COM TO BE CONSIDERED. Please be advised that your application is not complete until you fill out, sign, and submit an Application for Employment for a specific position for which Rochelle Community Hospital is actively recruiting. Your application must reflect that you possess the required qualifications for the position.
No sponsorship is available for this position.
No agencies or 3rd party vendors.
POSITION SUMMARY
Responsible for providing support to professional billing operations of employed providers including occupational health/client billing. Follow guidelines as established in accordance with UB04 and HCFA1500 billing guidelines. Coordinate billing processes to ensure accounts are billed to the appropriate payer by following appropriate billing regulations. Position is also responsible for monitoring scheduled services for, and obtaining, prior-authorization when necessary.
Position Duties and Responsibilities
- Work closely with Billing Compliance Analyst to ensure prior-authorizations are in place prior to rendering service for applicable procedures.
- Communicate with internal and external providers/staff to obtain clinical information necessary to obtain prior-authorizations
- Coordinate with Patient Access and other scheduling departments to ensure verification of prior authorization is present prior to services being rendered. Interact with scheduling department to cancel procedures if necessary for no authorization.
- Assist Senior Clinic Billing Specialist with unbilled accounts, claim problems and payment resolutions related to billing errors and charge master revisions.
- Monitor unbilled report and clear edits as defined for charge date errors, credit balance postings, etc. Provide back up for daily billing functions during shortages.
- Assist with government audits as needed, which may include preparation of logs, bad debt spreadsheets, etc… including Medicare, Medicaid audits or other contracted agencies as requested.
- Maintain working knowledge in both Meditech and Athena EHR systems to perform assignments. Record activities in both systems for purpose of audit trail.
- Maintain CEU requirements for department as outlined in the CEU policy. Must complete annual skills testing to ensure knowledge is complete to perform assigned duties.
- Other duties as assigned.
Job Qualifications (Knowledge/Skills)
- High school graduate or GED equivalent.
- Minimum of 3 years healthcare experience working with the prior-authorization process or referral centers in a hospital or clinic setting.
- High computer literacy especially navigating payer websites and online provider portals to submit and track prior-authorization requests.
- Able to work independently with detail problem solving skills with accurate attention to detail.
- Must have a positive attitude and be a team player.
- Exceptional communication skills working with patients, providers (internal and external), and staff.
- Knowledge of ICD-10, CPT and HCPCS coding required.
- Strong medical terminology required.
- Proficient with MS Office (Word, Excel, Outlook).
Rochelle Community Hospital Association positions are guidelines. They are not intended to identify every task that an employee will be asked to do. They are intended to provide a general outline of the work, responsibility and qualifications of the position. Employees are expected to provide whatever assistance is needed so that both individual and organizational success can be achieved.
Equal Opportunity Employer. All qualified applicants will be considered without regard to race, color, religion, gender identity, national origin, sexual orientation, age, marital status, medical condition, physical or mental disability, protected veteran status, or any other legally protected status.
