POSITION CRITERIA: Responsible for focusing on assigned TruBridge system accounts receivable requiring complex initial claims submission or resubmission. Responsible for reviewing RCM reports and accounts receivable aged trial balance to focus on accounts > 30 days requiring claims resolutions. Assist with resolving claims on the held list as assigned. Assist with insurance appeals as needed. Review daily reports as assigned including 72-hour report and the late charge report.

JOB FUNCTION:

• Responsible for reviewing accounts receivable in the TruBridge system requiring complex initial claims submission or resubmission.
• Responsible for running accounts receivable aged trial balance reports, weekly queue held reports, and distributing to appropriate staff as assigned.
• Responsible for reviewing accounts receivable > 30 requiring a claim resolution.
• Responsible for researching claims information in the RCM system on insurance portals.
• Responsible for working follow-up claim queues in the electronic health record system.
• Efficient in utilizing EHR system(s).
• Follows AIDET communication with patients and coworkers.
• Other duties as assigned.

JOB QUALIFICATIONS:

Education:

1. High school diploma required or equivalent required.
2. Experience in hospital and pro fee billing preferred.
3. Keeps abreast of hospital billing and professional fee billing guidelines.
4. Attends educational sessions and courses related to hospital and professional fee billing.

Job Knowledge/Experience:

1. Prior experience in hospital billing and physician professional fee billing required.
2. Prior experience with TruBridge A/R system and Trubridge RCM systems preferred.
3. Understands ICD-10 and CPT coding.
4. Knowledge of medical terminology
5. Knowledge of office programs: Microsoft Word and Excel

Skills:

1. Strong communication skills.
2. Calm, professional demeanor
3. Ability to work productively under stress.
4. Able to judge situations and seek appropriate assistance if it is beyond the scope of practice.
5. Physical Demands:
6. Must be able to sit and concentrate for long periods of time. Light lifting, bending, and reaching may be required.
7. Must be able to communicate effectively orally and in writing with other departments and employees.
8. Minimal lifting required.

Confidentiality:

1. Must be trained and abide by HIPAA regulations.

Internal/External Contacts:

Internal: CFO, Controller, HIM Director, Revenue Cycle Management Coordinator, and Registration Supervisor.

External: Patients, Representatives from the electronic health record system, insurance

representatives