Current Employees:

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Primary Location

Rapid City, SD USA

Department

Home Plus RC Home Care Services

Scheduled Weekly Hours

40

Starting Pay Rate Range

$20.75 - $25.94

(Determined by the knowledge, skills, and experience of the applicant.)

Job Summary

Provides an escalated level of claim processing to ensure the proper interpretation, processing, recording, approval and payment of inpatient and outpatient medical claims. Accurately reviews information for processing claims into a computerized system in accordance with the primary payer specifications and billing guidelines. Resolves more complex billing issues and provides training and mentoring to those in a Biller I and Biller II role. This role also supports the Revenue Cycle/Patient Financial Services functions by leading priorities, developing processes/workflows and ensuring that critical information is communicated to our billing team related to work with third party providers/payers that are required to maintain successful billing processes/practices. This important role will require an ongoing, daily operational support from TPA/Payers to PFS teams. This position is involved and leads special projects tied to complex claim issues and well as key contact and coordination of our system clearinghouse.

Monument Health offers competitive wages and benefits on qualifying positions. Some of those benefits can include:

*Supportive work culture

*Medical, Vision and Dental Coverage

*Retirement Plans, Health Savings Account, and Flexible Spending Account

*Instant pay is available for qualifying positions

*Paid Time Off Accrual Bank

*Opportunities for growth and advancement

*Tuition assistance/reimbursement

*Excellent pay differentials on qualifying positions (extra pay for working evening, nights or weekends)

*Flexible scheduling

Job Description

Essential Functions:

• Demonstrates application of compliance standards and payer specific data to properly file claims and ensures prompt, appropriate reimbursement of services and supplies billed to third parties and appropriate payment of services and supplies due from patients, as evidenced by documentation, observation and feedback.
• Proficient in third party payer procedures including, but not limited to: Blue Cross, Medicare, Medicaid, Indian Health Services, Tricare, Biller I Payers (commercial, VA, Workers Compensation, third-party liability, county) and all other third party contractual agreements as required.  May be asked to demonstrate specific knowledge for more complex billing models, such as, but not limited to: rural health and dialysis.
• Knowledgeable in split claim processes, specific to governmental payers.
• Demonstrated knowledge of 24/72 hour overlap rules in move charges and prevent denials.
• Thorough understanding of the Medicare portal in order to adjust and void claims and verify eligibility.
• Partner with internal caregivers to resolves complex billing issues for the self-pay and customer services teams.
• Monitors department metrics to draw conclusions regarding claims submission issues that might require Compliance and Charge master staff to resolve, or HIPAA transaction code set review. Research payer requirements and offer suggestions to leadership for claims submission issues.
• Manages and reconciles daily claim runs between EPIC and clearinghouse as needed.
• Serves as a point of contact with TPA/Payers to support required needs of PFS billing department.  Takes initiative to research problem issues, identifying root cause and develops successful outcomes that support the purpose of TPA relationship. 
• Provides daily, ongoing support with TPA/Payer that ensures completed objectives for the PFS department.
• Leads complex projects related to issues with complex payers which may result in new Revenue Cycle workflow changes
• Leads  coordination of Clearing House processes, issues, rejections for the health system.   Ensuring IT system builds are coordinated and implemented for successful claim administration.
• All other duties as assigned.

Additional Requirements

Required:

Education - High School Diploma/GED Equivalent

Experience - 3+ years of Billing/Collections Experience; 3+ years of Revenue Cycle Experience

Preferred:

Certifications - Certified Revenue Cycle Specialist (CRCS) - American Association of Healthcare Administrative Management (AAHAM)

Physical Requirements:
Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.

Job Category

Revenue Cycle

Job Family

Credit and Collections

Shift

Employee Type

Regular

40 Monument Health Home Plus

Make a difference.  Every day.

Monument Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.