Premier Health

To manage the accounts receivable for timely and maximum reimbursement by adhering to company billing and collection policies. In addition the team lead, will review coding & charges, ensure the completion of team members daily task, and follow-up with external and internal customers to ensure the remediation of customer issues that may arise. The team lead should communicate with the AR Manager concerning central billing issues, questions, concerns, corrective actions or training needs.

Team Leader Responsibilities and Duties:

The Medical Billing Specialist Team Leader is responsible for the entry of all data processed through the Accounts Receivable Office; including all system documentation, charges, payments (lockbox & mail), adjustment and other transactions. The Medical Billing Specialist performs daily, monthly and special system processing requirements (i.e. batch posting and balancing).

1) Coding/Charge Review

a) Ensure Team Members are completing tasks/job functions timely

• Coders receive charges from centers
• Coders code charges within 1 day/24 hours of receipt of charge from centers
• Coded charges/charge slips to Charge Entry team same day as coding completed
• Charge Review team defers any charge not accepted with notes indicating why the charge is deferred

b) Work with CBO AR Manager to develop a common (all CBO centers) way for each center to report charges (surgery, hospital rounding, etc.)

c) Work with CBO AR Manager/CBO Administrator to implement coding education for CBO staff

2) Customer Service

a) Faxes, mail and courier items distributed immediately (utilizing mail boxes at front door rather than interrupting staff at work stations)

• Charges received via fax are batched using a Batch cover sheet
• Batch is logged into the Extraction Log on the CBO Shred Drive
• Batch is delivered to the correct coding staff member’s mailbox

b) Hardcopy and Secondary Claims printed daily

c) Verify BWC claim/info is correctly processed

3) Charge Entry

a) Ensure team members are completing tasks/job functions timely

• Manual charge entry batches are being received promptly from coding
• Charges are keyed into Epic within 1 day/24 hours of receiving from Coding
• Extraction Log is completed once batch is keyed into Epic

b) Determine that work/charges to be keyed are evenly distributed to each team member

• Each team member is expected to inform team leader when they are behind

c) Check/Spot check team members’ work for errors

4) Payment Posting

a) Ensure team members are completing tasks/job functions timely and according to guidelines

• Payments are posted within 24 hours of deposit to bank
• Payments batches are balanced to EPIC daily, utilizing the PB Payment Activities report
• Spreadsheets are balanced to bank every Monday; if team member is off on Monday, balancing to be performed the day before PTO begins
• Reconciliation items from previous month are posted prior to beginning current month’s payment posting

b) Verify that team members are saving their work to the CBO shared drive

• Lockboxes- Daily
• Bank balancing spreadsheet- Weekly
• Spreadsheets- As updated

c) Check/Spot check team members’ work for errors

d) Perform audits as requested by CBO AR Manager/CBO Administrator and randomly (determine if payment posted has difficulty with balancing and audit frequently)

e) Work with ERA Claims Specialist to resolve missing ERAs for entire team

• Verify that ERAs are posted using Check Member not just deposit amount

5) Follow Up

a) Ensure team members are completing tasks/job functions timely and according to guidelines

• WQs are current according to guidelines
• Credit WQs are being worked at least one hour per day
• ROA payments are distributed within 24 hours of center collecting payment

b) Check /Spot check team members’ work for errors

c) Work with CBO AR Manager/CBO Administrator to redistribute responsibilities to accommodate new staff member and to ensure work is evenly distributed

d) Verify that information is being deferred correctly and all encounters that are deferred have notes indicating why it is deferred

6) All Team Functions

a) Report an updates, concerns, issues during weekly Team Lead meetings

b) Answer questions from team members and center staff

c) Educate/Inform staff regarding changes, updates, etc

d) Monitor team members use of work time to handle personal business

• Socializing with co-workers
• Personal phone calls

e) Communicate Roadblocks/Issues to CBO AR Manager

f) Ensure consistency among staff, workflow, etc.

g) Cross Train/ “Buddy Billers”

• Other duties as assigned by CBO AR Managers/CBO Administrator

Qualifications

1. High School diploma or GED

2. Three to five years previous healthcare billing, collections experience, and/or managed care experience preferred.

3. Knowledgeable about third party billing regulations and CPT.4/ICD.9/10 coding

4. Routine CRT/data entry skills

5. Knowledge of spreadsheet applications

6. Proven record of dependability

7. Strong communication and decision-making skills

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