Facility

Cape Fear Valley Medical Center

Location

Fayetteville, North Carolina

Department

Patient Financial Services Operations

Job Family

Clerical

Work Shift

Days (United States of America)

Summary

Handles the complete processing of patient accounts with third party carriers from start to finish to include but not limited to: billing the claim either electronically or paper, supplying additional information necessary for claim adjudication, and answering patient and insurance company questions.

Major Job Functions

The following is a summary of the major essential functions of this job.  The incumbent may perform other duties, both major and minor, that are not mentioned below.  In addition, specific functions may change from time to time:

• Submits primary insurance claims to all carriers using the electronic claims terminal or send hard copy claims

• Uses the on-line work list and account referrals to review accounts that are pending payment from insurance companies for additional information

• Validates the accuracy of patient information so that future billing and follow-up activities are conducted effectively and to ensure a high degree of customer service. 

• Applies adjustments and write-offs to accounts according to policy and procedure to assure accurate account balances and statements

• Maintains a suspense file of accounts that need additional documentation for eligibility determination prior to billing

• Receives incoming calls from patients and/or insurance companies concerning open accounts and answers questions and provides information in a courteous and cooperative manner to maintain good customer relations

• Other duties as assigned

Minimum Qualifications

The following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this job:

Education and Formal Training: 

• High school diploma or equivalent required

Work Experience: 

• 2 year’s experience with electronic hospital billing or collections in a medical field

• Knowledgeable in third party claim adjudication to include: Medicare, Medicaid, Tricare, commercial insurance, and managed care

• Medical terminology and familiarity with CPT-codes, ICD-10 codes and HCPCS codes preferred

• Prior experience with personal computer software and other office equipment required

Knowledge, Skills, and Abilities Required: 

• Must pass departmental training (calculating reimbursement, UB-04, Patient Account Terms and System Navigation) tests 75% or higher

• Excellent verbal and written communication skills

• Analytical ability and accurate mathematical calculation skills

Physical Requirements: 

• Near visual acuity required

• Motor coordination and finger dexterity required to complete repetitive functions with computer and other office equipment

• Ability to lift twenty-five pounds

• Ability to talk and to receive information by telephone is required

Required Licenses and Certifications

Cape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity