<p>Position Summary</p> <p>The WPHPA Medical Biller is responsible for timeliness & accuracy of charge entry, denial management and monitoring of non-payments. This position is an important role for the day to day management of the front end revenue cycle. The Medical Biller is responsible for preauthorization of radiation oncology treatments and diagnostic orders, as well as charge review and posting for radiology treatmetnts. The Medical Biller will confirm patient insurance details, verify eligibility of insurance coverage, and obtain authorization. The individual will document and track all communication attempts with insurance providers and health plans, follow up on denials, arrange peer-to-peer and appeal reviews. The individual will ensure timely and accurate communication with healthcare staff and patients on status of authorization. In this role, you will be part of the overall administrative team of the Radiation Oncology department and will have some scheduling responsibilities as well.</p> <p>Essential Functions and Responsibilities Includes the Following:</p> <ol> <li> <p>Understands and adheres to the WPH Performance Standards, Policies and Behaviors.</p> </li><li> <p>Monitor the clean billing of claims in the physician practice and ensures that all claims are billed expeditiously</p> </li><li> <p>Demonstrates a complete understanding of all Insurance companies; their policies, guidelines and contracts.</p> </li><li> <p>Takes initiative to remain informed as changes in coding rules/guidelines, actively reads/researches and keeps abreast of changes in the industry.</p> </li><li> <p>Identify/trend denials and provides recommendations to improve processes/provide additional training to front end staff etc.</p> </li><li> <p>Monitor write-offs with the objective of minimizing these losses.</p> </li><li> <p>Actively pursue all non-payments identifying the cause and provide recommendations for corrective solutions.</p> </li><li> <p>Act as resource to front-end and/or clinician for coding questions.</p> </li><li> <p>Fulfills organizational responsibilities as assigned including respecting/promoting patient rights; responding appropriately to emergencies; communicates concerns/ problems relating to patients and/or staff with immediate supervisor.</p> </li><li> <p>Adheres to White Plains Hospital infection control standards including, but not limited to, hand hygiene, use of PPE, isolation of patient with known infectious disease, and equipment disinfection/sterilization.</p> </li><li> <p>Utilizes appropriate steps in the decision-making process to include recognition and priority setting relating to patient care and practice based issues.</p> </li><li> <p>Collaborates and communicates with the health care team</p> </li><li> <p>Completes annual mandatory requirements including Occupational Health Requirements.</p> </li><li> <p>Attends mandatory in-services</p> </li><li> <p>Attends staff meetings as required/requested</p> </li><li> <p>Performs all other related duties as assigned.</p> </li></ol> <p>Education & Experience Requirements:</p> <ul> <li>Minimum of 3 years billing experience, coding experience preferred. High school graduate or GED certificate. </li><li>BS degree preferred. Demonstrated understanding of revenue cycle and the impact of front-end sponsorship work on billing and collection efforts. </li><li>Demonstrated skills in problem assessment, and resolution and collaborative problem-solving in complex, interdisciplinary settings. Ability to work collectively with a culturally diverse staff and patient/family population, strong customer service skills, demonstrating tact and sensitivity in stressful situations. </li><li>Proficiency in health insurance eligibility as it pertains to Medicare and Medicaid regulations, insurance and managed care reimbursement concepts and overall operational impact. Basic medical terminology. </li></ul> <p>Core Competencies</p> <ul> <li>Ability to work independently, as well as part of a team, and follow-through and handle multiple tasks simultaneously. </li><li>Ability to communicate effectively both verbally and written and work with others </li><li>Ability to concentrate on fine details with constant interruptions • Perform multiple duties in a high volume area </li><li>Ability to deal professionally and efficiently with all levels of management and external constituencies </li><li>Self-starter, self-motivated and ability to work without supervision • Flexible, organized and able to set priorities </li><li>Demonstrates team work and adaptability </li><li>Maintains composure under stress </li></ul> <p>Physical/Mental Demands/Requirements & Work Environment</p> <ul> <li>Ability to perform computer work for extensive periods of time </li><li>Occasionally move and/or transport of 15 to 20 pounds </li><li>Requires movement about the department frequently throughout the day </li><li>Ability to remain in stationary position for extended periods of time. </li></ul> <p>Primary Population Served Check appropriate box(s) below:</p> <p>All Populations</p> <p>The responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of White Plains Hospital.</p>