Job Description

University of Utah Job Description

Job Summary

Follows patient accounts through the entire billing process from eligibility to completion of payment process. Provides medical billing and collection processes by verifying eligibility and benefits, obtaining pre-authorizations, entering medical codes, requesting payments and resolving account issues.

Qualifications

Three years medical billing experience and one year of coding experience using ICD-10-CM or equivalency required. Thorough knowledge of entire billing process, demonstrated computer skills, human relations and effective communication skills are also required.

This position is not responsible for providing patient care.

Care is appropriate to the population served

Applicants must demonstrate the potential ability to perform the essential functions of the job as outlined in the position description.

Disclaimer

This job description has been designed to indicate the general nature and level of work performed by employees within this classification.  It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to the job.

Essential Functions

1. Contacts patients and insurance companies for payments requests, overdue payments, denied claims and arranges payment plans.
2. Enters medical codes from patient charts for visits or procedures and ensures compliance and correct coding practices.
3. Contacts insurance companies for explanation of benefits, pre-authorizations and to resolve claim issues.
4. Produces reports to reduce age trial balances by contacting patient for collection or sending secondary claims.
5. Provides customer service to patients by educating them on insurance policies, billing procedures and coding issues.
6. Calls patients and insurance companies to follow-up with account information.
7. May provide training to others on billing procedures and practices.

Problem Solving

The Billing Specialist directly affects the unit or clinic profitability by following up for payment and accurately coding visits and procedures. This position has the authority to negotiate payment settlements for patients or with insurance companies and authorize patient discounts within the policy and procedure guidelines.

The incumbent resolves issues with insurance companies regarding incorrect registration information, claims processing, contract reimbursement amounts and coding issues.

Comments

Work Environment and Level of Frequency typically required

Nearly Continuously: Office environment.

Physical Requirements and Level of Frequency that may be required

Nearly Continuously: Sitting, hearing, listening, talking.

Often: Repetitive hand motion (such as typing), walking. 

Seldom: Bending, reaching overhead.

The staff member must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit.  The individual must demonstrate knowledge of the principles of life span growth and development and the ability to assess data regarding the patient's status and provide care as described in the department's policies and procedures manual.