Provides billing support for the Advanced Diagnostic Laboratories (ADx) at NJH. Responsible for coordinating and monitoring the flow of billing data within the clinical laboratory departments and other information system databases. Analyzes and evaluates clinical financial data, recognizes inconsistencies, and initiates the resolution of billing problems. Assists Client Services to immediately resolve billing inconsistencies and delinquent data. Implements billing plans designed to meet timely billing deadlines, and consult the Patient Financial Services (PFS) Department when applicable. Acts as liaison between ADx and the PFS Department to facilitate problem solving. Responsible for billing data, diagnosis, discharge and exception reports generated by the billing information systems to promote accurate financial billing.
1. Establishes and maintains ADx financial policies and procedures. Ensures that ADx complies with all College of American Pathologists (CAP) and HIPAA requirements.
2. Maintains clinical billing compliance for inpatient and outpatient (Client Accounts) with Medicare, Medicaid, Institutional Guarantors and other private insurances for accurate, successful reimbursement.
3. Performs database surveillance and maintenance for all billing applications and interfaces. Maintains high standards of performance for operation of all Detailed Financial Transactions (DFTs). Monitors billing interfaces. Reconciles price and CPT changes for reference lab testing.
4. Investigates new and emerging CPT coding that will enhance the billing in the LIS including but not limited to DRGs, CPTs, 837 (Medicare exception report) and timely billing practices.
5. Uses LIS and HIS auditing reports to verify the accuracy of patient and client billing.
6. Responsible for error reports (EXR/SIN/BR) and DFTs of clinical application system.
7. Troubleshoots billing issues to a point of adequate resolution or until the issues are at least identified as to cause and effect. Troubleshoots all issues related to the patient billing interface, including coordination of late charges and establishing necessary accounts in the HIS.
8. Instructs users of the proper use of billing application programs including: Quick-OP Admits, Sunquest GUI, Manual Billing and Charge Master Verification.
9. Assists with the performance of a variety of client services issues when delinquent billing data is received. Including but not limited to Admitting, Discharging and Transferring (ADT) of patient data, Insurance (Third party billing), UPIN, EDI, NPI, SSN, Diagnosis and Guarantor entry.
10. Processes check and credit card payments using online system.
11. Performs product verification/validation and document outcomes of billing software and/or hardware changes or enhancements implemented.
12. Moves charges when necessary to assure accurate billing derived out of the LIS and HIS.
13. Analyzes processes and applies critical thinking skills to the LIS and HIS and EMR systems. Serves as a backup to the LIS staff for new client accounts.
14. Clerical duties may include using printers, faxes, and sending mail, deliveries to on-campus locations, requisition scanning, handling phone calls, filing, archiving, labeling, sorting, and photocopying.
15. Communicates effectively with Client Services in every department within ADx, NJH Patient Financial Services (PFS), LIS, HIS and other vendors used by ADx.
16. Performs all other duties as assigned.
1. Performs, as directed, safety compliance and uses Personal Protective Equipment (PPE), as needed.
2. Participates in Quality Assessment (QA) and Quality Improvement (QI) programs, as directed.
3. Ensures compliance with The Joint Commission and all other Federal, State and Regulatory Agencies.
4. Responds promptly and sincerely to customer’s needs, requests and concerns via all communication forms using easily understood language and refraining from using inappropriate language and non-verbal gestures.
5. Maintains positive working relationships as a team player through problem solving issues, speaking positively about others, listening attentively and observing the Patient Bill of Rights and Confidentiality.
6. Increases customer service knowledge, skill and ability by participating in department and institution-wide specific programs.
7. Incorporates National Jewish’s identity (Science Transforming Life®) into daily functions. Speaks positively about the institution, provides customers with prompt service, maintains a clean and safe working environment, dresses appropriately based upon National Jewish safety standards, and departmental policies and wears an ID badge visibly.
Knowledge and Skills
Demonstrated basic knowledge of medical terminology. Possesses outstanding customer service skills, excellent interpersonal communication, writing and verbal skills. Must possess time management, organizational, troubleshooting and problem solving skills. Demonstrate proficiency in typing and utilizing office suite software, and the Internet. Must be detail oriented, meet deadlines, and have the ability to communicate effectively and professionally to clients and hospital staff. Must be punctual, reliable, and professional, make independent decisions, work as a team player, and work overtime as needed. Must possess the ability to read, write and understand English and perform basic mathematical computations.
High school diploma or GED required
Certification and Licensure
A minimum of one (1) year of recent and related hospital, clerical, and medical insurance experience within a healthcare environment required.
- or - Any equivalent combination of Education and/or Experience
Position is an office environment. Frequent requirements may include: sitting for extended periods, entering and manipulating data on a workstation computer and participating in team/executive meetings. Approximately 75% of daily responsibilities will be working both one-on-one and in teams with other personnel and extended one-on-one contact in a quiet environment where hearing and listening is paramount. Must possess the ability to communicate by observation, verbal, written and listening; standing; walking; climbing stairs; stooping to remove/replace files; good hand-eye coordination; lifting, pulling, pushing, and upper body twisting while handling supplies and equipment; sitting while completing paperwork; using keyboard for PC and word processing needs. Occasional requirements may include: stand, walk, use hands to manipulate, handle or feel objects, tools, or controls, reach with hands and arms, stoop, kneel, and lift/move up to 25 pounds. Incumbent may be scheduled to work an alternate schedule to accommodate essential business needs routine travel by foot or automobile to alternate work/meeting locations, possibly during inclement weather.
Inside environmental conditions may include: Professional office environment with time of each day spent in interaction with management/staff, in addition to planning and working autonomously. Requires teamwork and the ability to handle multiple interruptions; frequently fast-paced; high-pressure; occasionally variable-paced; variable pressure. Occasionally, while working in a laboratory/medical research environment, potential hazards may result from odors, animals, exposure to body fluids from contagious patients, electricity, mechanical devices, chemicals and radiation; occasionally working conditions involve hazards that include extreme temperature changes, heat, mechanical, biological and chemical substances. Personal Protective Equipment (PPE) will be provided to each employee when needed as determined by policy. Utilization of PPE is mandatory. Estimated 1500 employees in the worksite.