BILLER I - South Central Health System : Job Details

JOB SUMMARY Job Class: Biller I-II-III-IV Department: 9630- Patient Accounts / 9630- Clinic ManagementCORE DUTIES AND RESPONSIBILITIES Demonstrates Competency in the Following Areas: GENERAL FUNCTION: This training position is accountable for learning how to process all commercial insurance claims accurately and timely on 1500 and UB04 forms. Commercial insurance claims include: Blue Cross, Workmen's Comp, HMO & PPO insurances, Champus, Contractual policies, etc... Timely follow-ups on claims to ensure payments are received. JOB DUTIES: -Maintain established policies and procedures, objectives, quality assurance program and safety standards. -Research all information to complete billing process. -Accurate filing of all claims. -Answer any inquiries regarding billing of accounts. -Maintain department records, reports, and files as required. -Participate in educational programs and in-service meetings. -Perform other job duties as assigned or requested. MINIMUM QUALIFICATIONS: -Must be able to type 30 wpm with computer skills -Must be able to read and write and have good communication skills -Billing experience preferred TRAINING TIERS A Biller I is considered a trainee. A trainee has three (3) months in which to demonstrate competency on three (3) of the following skills. Should the trainee not meet this goal, they may be transferred to a lesser position, retrained or terminated

• Create Encounter
• Key Changes
• Verify Insurance
• Release Charges
• Correct Rejections
• Answer Phones

A Biller I/Trainee has six (6) months in which to demonstrate competency in all of the above areas. Once demonstrated, trainee will be moved to a Biller II. Should the trainee not meet this goal, they may be transferred to a lesser position or terminated. A Biller II has six (6) months from becoming a Biller II to demonstrate competency in three (3) of the following skills:

• AR Follow Up
• Work Denials
• Review Claims and make necessary corrections
• Follow up on insurance
• Make Corrections

The Biller II will be moved to a Biller III. Should the Biller II not meet this goal, they may be transferred to a lesser position or terminated. A Biller III has six months from becoming a Biller III to demonstrated competency in all areas listed for the Biller II. A Biller III will be moved to a Biller IV when all areas are mastered. CONTACTS: -Within organization-all departments -Outside organization-insurance companies, doctor offices, nursing homes, patient employers, vocational rehabilitation, and welfare department. DECISION MAKING: -Decision taken to supervisor for approval:

• ETO Time
• Clarification of changes of a procedure