Cardiology Associates, P.C.
Position Description
Position Title:
Billing Representative
Reports To: (Title)
Office Manager
Location: (Circle One)
K Street / Annapolis
Job Holder:
________________________
Immediate Supervisor:
________________________
POSITION PURPOSE:
Coordinate and input accurate patient information into Practice Management System to facilitate
the billing and collection process.
QUALIFICATIONS: (academic and clinical preparation and licensure; certification requirements; experience required)
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High School Diploma
Minimum of 2 years billing experience in a medical setting required, cardiology experience
preferred
Demonstrated expertise in medical terminology, ICD 9-CM and CPT coding.
Demonstrated expertise in policies, procedures, rules and regulations of insurance companies.
Demonstrated effective oral and written communication skills.
Demonstrated analytical and problem solving skills
REPORTING RELATIONSHIPS:
This Position Reports To:
Office Manager (Title)
Reporting To This Position:
None
ESSENTIAL FUNCTIONS:
1. Prepare and enter patient demographic information into the Practice Management system by
following guidelines outlined in the collection policy manual to ensure maximum
reimbursement from payors.
2. Prepare and input patient charges into the Practice Management system by following
procedures outlined in the Collection Policy Manual to ensure charges are entered within 1-2
days of date of service.
3. Resolve referral errors before sending them to AR Department by reviewing dates, billed
procedures listed, and signature of the primary care physician within 2 days of posting
charge.
4. Identify and forward referrals and authorizations to AR Department within 2 days of date of
service by reviewing batch worksheet to ensure claims are mailed from AR Department with
appropriate documents.
5. Assist appointment secretaries and physicians by identifying problem billing patterns and
answering questions regarding insurance requirements and regulations to ensure maximum
reimbursement from payors.
6. Resolve all billing sheet discrepancies within 3 days after end of month by maintaining a log
of charge slips given back to physicians to ensure all charges are entered into system.
7. Answer the telephone in a positive and professional tone of voice before the fourth ring and
direct or resolve it appropriately in order to ensure each call is handled efficiently.
8. Schedule appointments and enter all relevant patient information by utilizing the Practice
Management System to ensure proper preparation of the chart and billing information prior to
the time of appointment.
9. Maintain a regulatory/compliance environment by following organizational policies and
procedures to ensure compliance to state, local, and federal standards and regulations.
10. Other duties as assigned
SPECIFIC REQUIREMENTS
FOR SATISFACTORY PERFORMANCE
1. Patient Information:
A. Ensure patient demographic and insurance information
is accurately entered into computer system.
B. Ensure accurate financial and insurance classes are
entered on patient’s account.
2. Charge Entry:
A. Compile and verify all fee tickets against appointment
schedule
B. Ensure charges are entered accurately and timely
C. Ensure charge batch balances
D. Ensure appropriate modifiers and CPT codes are used.
3. Referral Errors:
A. Ensure referrals have dates, signatures and appropriate
procedures listed
B. Educate receptionists when adverse trends are spotted
C. Assist patients in communicating with referring
physicians regarding referrals
D. Send referrals to AR Department in a timely manner
4. Referrals and Authorizations:
A. Ensure necessary referrals are acquired
B. Ensure authorization numbers are entered in
appropriate location in Practice Management System
C. Send referrals to AR Department in a timely manner
5. Resource:
A. Effectively communicate with appointment secretaries
regarding referral errors
B. Ensure physicians are billing correctly and
communicate with management if negative trends are
noticed
6. Billing Discrepancies:
A. Ensure all discrepancies are resolved satisfactorily
B. Alert physicians to missing charges
TRACKING
SOURCE/FREQUENCY
A. Direct Observation
B. Billing Reports
A. Billing Reports
B. Billing Reports & Direct
Observation
C. Direct Observation
D. Billing Reports & Direct
Observation
A. Direct Observation
B. Direct Observation
C. Direct Observation
D. Direct Observation &
Self Report
A. Direct Observation
B. Direct Observation
C. Direct Observation &
Self Report
A. Direct Observation
B. Direct Observation
A. Direct Observation
B. Billing Reports & Direct
Observation
SPECIFIC REQUIREMENTS
FOR SATISFACTORY PERFORMANCE
7. Telephone:
A. Answer the phone, identify the purpose of the call
and direct or resolve the call appropriately
B. Transfer call and/or take complete, accurate messages
for physicians and staff members
C. Alert clinical staff to patient/medical messages and
provide patient chart along with message
D. Answer multiple phone lines and follow practice
policies when it is necessary to place a call on hold
8. Scheduling:
A. Utilize Practice Management system to schedule
appointments for practice appointments/procedures
B. Verify patient demographics (ie., correct spelling of
full name, current phone numbers and date of birth)
at the time of scheduling.
C. Determine the patient’s insurance coverage and
inform the patient of relevant office policies (i.e.,
needed referral, co-pays) in compliance with the
Collections Policy Manual.
D. Call all patients to remind them of their appointments
E. Inform patients of special instructions as appropriate
for their scheduled visit/procedure.
9. Regulatory/Compliance Environment:
A. Follow practice policies & procedures as well as
rules established by outside regulatory bodies
TRACKING
SOURCE/FREQUENCY
A. Direct Observation
B. Direct Observation
C. Direct Observation
D. Direct Observation
A. Direct Observation
B. Direct Observation
C. Direct Observation
D. Direct Observation
E. Direct Observation
A. Direct Observation
WORKING CONDITIONS: (physical effort, environment, hazards)
1.
Occasionally required to lift approximately 25 pounds.
2.
Work in well lighted and ventilated area.
3.
Required to sit and work up to 8 hours per day at computer screen.
4.
Overtime when required.
EQUIPMENT, TOOLS, MATERIALS USED:
Personal Computer: Practice Management System and Word Processor
Copier
Fax Machine
Visa/MasterCard Machine
Office Supplies
Multi-Line Telephone
CONTACTS: (nature and frequency)
Internal:
Office Manager - daily
AR Manager - daily
Physicians - daily
Office Staff - daily
External:
Patients and Patient Families - daily
Staff and Physicians from other Offices and Hospitals - daily
Insurance Representatives - daily
PARAMETERS/WORK DIRECTION PROVIDED:
The Office Manager gives final approval for purchases of equipment and supplies, requests for
training, requests for additional work, or assistance with current work load.
MAJOR CHALLENGES TO THE POSITION: (nature and variety)
1.
Must be able to work in fast paced environment.
2.
Must be able to identify trends in accounts receivable.
3.
Must be able to maintain patient confidentiality.
4.
Must be able to handle difficult situations/personalities in a professional manner.
PERFORMANCE MEASUREMENT:
1.
Accuracy of charges entered
2.
Ability to work as a team member
3.
Adherence to collection policies
4.
Feedback from Office Manager, AR Manager, Administrator, and staff
5.
Performance Review