Citizens Medical Center is a not-for-profit hospital known for compassionate patient care, clinical expertise, and bringing advanced medical services to the South Texas region since 1956. Today, Citizens is a 338-bed acute care hospital with over 1,000 dedicated employees.
Citizens offers a generous benefit package that includes retirement plans upon hire, and an excellent medical plan with optional insurance plans to choose from.
If you are interested in pursuing a career with an award-winning hospital, welcome home.
The Physician Biller I is responsible for post-service verification and data entry of patient demographics, insurance eligibility, and benefit verification. Calculates, communicates, and collects patient financial responsibility after services are provided, as appropriate. Negotiates, processes, and follows up on payment plan agreements. Files insurance claims and works rejected or errored claims, and assists the CMP clinics as appropriate.
Physician Biller II performs all responsibilities listed above independently. Additionally, is responsible for reviewing EOBs/ERAs for errors or denials and forwarding for correction or appeal; working insurance and patient accounts receivable; resubmitting claims after correction; and appealing denied claims using internal templates.
Post-Service Patient Access Duties:
* Verify patient demographics and proper completion of all required patient registration forms, including accurate data entry into practice management system. (EF)
* Verify medical insurance eligibility and benefit coverage, including accurate data entry into the practice management system. (EF)
* Obtain insurance referrals and authorizations. (EF)
* Determine or calculate patient financial responsibility using all available tools (e.g., insurance patient estimators, internal calculation spreadsheets, insurance fee schedules, etc.).
* Screen clinic schedules for high balances and bad debt utilizing all available tools (e.g., Phreesia, practice management system, etc.) and attempt to collect prior to the scheduled appointment.
* Collect, process, post, and deposit patient payments, including working the prepay bucket in the practice management system. (EF)
* Sort, transport, and deliver mail and interdepartmental mail throughout the hospital campus.
* Organize, process, and complete the deposit protocol daily, including data entry into the general ledger
* Set-up and process payment plan agreements and financial assistance applications, including delinquent payment follow-up. (EF)
* Reviews and corrects any claim rejections and edits, or forwards to the appropriate team member for correction, and resubmits rejected claims after correction. (EF)
* Document all patient, insurance, or other communication in accordance with departmental policy. (EF)
* Assist the CMP clinics with patient demographics, insurance eligibility, insurance benefit verification, and data entry. (EF)
* Consult team members, supervisor, director, and other appropriate resources to resolve billing and collection questions and issues. (EF)
* Review, print, and/or process patient statements in accordance with established timelines. (EF)
* Organize, process, and complete the deposit protocol daily, including data entry into the general ledger.
* Review insurance explanation of benefits and electronic remittance advices for errors and incorrect payment and forward for correction or appeal. (EF)
* Post insurance payments and adjustments, including posting transfers as appropriate. (EF)
* Work insurance accounts receivable in accordance with departmental protocols. (EF)
* Work patient accounts receivable in accordance with departmental protocols. (EF)
* Research, prepare, and submit appeals for billing denials using internal templates. (EF)
* Post small balance adjustments in accordance with departmental protocols. (EF)
* Research, collaborate, and communicate timely and professionally with internal and external clinicians, managers, clinics, hospital personnel, and departments to resolve any billing and other payer denials or rejections. (EF)
Hospital:
* Adheres to organization-wide and other applicable policies and procedures.
* Day-to-day performance complies with the hospital’s Service Excellence Behavioral Expectations.
* Performs within the prescribed limits of the hospital’s Ethics, Compliance and Confidentiality Program guidelines.
* Performs within professional Scope of Practice at all times.
Other Duties As Assigned:
* Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.
1. Physician Biller I: High School diploma or equivalent
2. Physician Biller II: High School diploma or equivalent, possesses intermediate knowledge of medical billing and coding.
Preferred:
1. Physician Biller I: Associates degree in a healthcare related field, possesses an entry level knowledge of medical billing.
2. Physician Biller II: Associates degree in a healthcare related field, possesses basic knowledge of medical coding.
EXPERIENCE
Required:
1. Physician Biller I: One year of current patient access experience in a physician office/practice setting within the last three years.
2. Physician Biller II: Two years of current medical billing experience in a physician office/practice setting within the last three years.
Preferred:
1. Physician Biller I: One year of current medical billing experience in a physician office/practice setting within the last three years.
2. Physician Biller II: Three years of current medical billing experience in a physician office/practice setting within the last four years.
SPECIAL SKILLS AND ABILITIES
Required:
1. Physician Biller I: Able to work in a collaborative team environment; good mathematical, verbal and written communication skills; able to organize and complete work in a timely manner; basic proficiency in Microsoft Office365 apps; basic proficiency using telephone, fax, and email.
2. Physician Biller II: Able to read, interpret, and communicate all parts of an explanation of benefits or electronic remittance advice; able to access and utilize the National Correct Coding initiative and Medically Unlikely Edits; able to work effectively within role independently.
Preferred:
1. Physician Biller I: Able to read, interpret, and communicate all parts of an explanation of benefits or electronic remittance advice; intermediate proficiency in Microsoft Office365 apps.
2. Physician Biller II: Advanced proficiency in Microsoft Office365 apps.
LICENSURE / CERTIFICATION REQUIREMENTS
Required:
1. Physician Biller II: Certified Medical Reimbursement Specialist (CMRS) certification or an approved, equivalent certification.
Preferred:
1. Physician Biller I: Certified Medical Reimbursement Specialist (CMRS) certification or an approved, equivalent certification.
2. Physician Biller II: Certified Medical Coding Specialist (CMCS) certification or an approved, equivalent certification.
COMPANY PROFILE
Citizens Medical Center is a not-for-profit, community hospital known for compassionate patient care, clinical expertise, and bringing advanced medical services to the South Texas region since 1956. Today, Citizens is a 317-bed acute care hospital with over 1,200 employees. Voted “Best of the Best” hospital in Victoria for 14consecutive years, Citizens Medical Center is a level III Trauma Center, with a newly renovated 24/7 Emergency Department that includes an onsite medical helicopter. Citizens hasacomprehensive Community Cancer Program that includes two linear accelerators and HDR brachytherapy. Citizens is recognized for its outstanding cardiology program which includes a nationally accredited Chest Pain Center and is a Primary Stroke Center. Citizens also includes a comprehensive, accredited Bariatric Surgery program,Birth Center with labor and delivery, animaging and surgery center, sleep study center, state-of-the-art rehabilitation and fitness center, urology center and daVinci robotics minimally invasive surgery options, a home health agency, andhas a long history of providing continuing education for healthcare providers and the community.
Citizens Medical Center is looking foremployees who actively demonstrate service excellence by exemplifying our iCare values. If you are someone who displays respect and enthusiasm for patients, visitors, and coworkers while consistently upholding the hospital’s commitment to providing outstanding outcomes, service excellence, and fiscal responsibility, then you could be a good fit for the CMC team!
BENEFIT OFFERINGS
Health
* STD, LTD Disability
* Supplemental Life, AD&D
* Flexible Spending (FSA)
* Employer paid life insurance and short term disability
Retirement/Investment
* 457(b) Deferred Compensation
* Paid Time Off
* Sick leave, Bereavement leave, Jury Duty/Witness Service
* Tuition Reimbursement
* Hospital-paid & administered annual immunizations
Citizens Medical Center is guided by its Mission – “to provide quality medical services at a reasonable cost to the citizens of the region.”
U. S. Patents 7,080,057; 7,310,626; 7,558,767; 7,562,059; 7,472,097; 7,606,778; 8,086,558 and 8,046,251.
#J-18808-Ljbffr