Medical Biller III

Job Overview:

The Medical Biller III role is to have set duties similar to an Account Specialist II to assist other account specialists with difficult and complex accounts. In addition to the duties of an Account Specialist II, this person will take on special projects assigned by the Supervisor/Manager. Will interact with departments directly related to Patient Accounting. (i.e. Medical Records, Revenue Management, Managed Care.)

Job Requirements:

• High School Diploma or GED Degree or GED (Required)

• 5 - 7 years’ experience (Required)

• Must have extensive knowledge and experience in Billing, Payer policies, and appeals 

• Exceeds individual productivity incentive standards 

• Ability to train and assist others 

• Works without direct supervision 

• Shows good attitude and leads by example

Job Responsibilities:

• Knowledge: Works with little to no supervisory oversight and exercises appropriate judgement in identifying payer trends. Identifies and appropriately communicates process improvement with team leaders and supervisors in a timely manner. Maintains a close working relationship with all departments and consolidates efforts to ensure appropriate and standardized coding/billing procedures are followed. Responsible for new hire and refresher training. Subject matter experts that demonstrate the ability to work independently, effectively managing tasks and responsibilities. 

• Quality Review: Consistently produces quality work and actions to move a claim to proper payment or account resolution while maintaining assigned work queues. 

• Personal Productivity: Completes assigned workload based on key performance indicators on a daily basis to ensure standard productivity is met. 

• Patient Accounting Cash: Meets or exceeds approved target; collects 100% of net revenue booked based on remittance. 

• Aging: Decreases AR greater than 90 days for Insurance accounts as set by department each year. Lower is better.

Other Related Information:

This person should be a self-starter and uses initiative. Thinks outside the box; good at problem solving.

Working Conditions:

Climbing - Rarely 
Concentrating - Consistently 
Continuous Learning - Occasionally 
Hearing: Conversation - Frequently 
Interpersonal Communication - Consistently 
Kneeling - Rarely 
Lifting <10 Lbs. - Rarely 
Lifting 50+ Lbs. - Rarely 
Lifting <50 Lbs. - Rarely 
Pulling - Rarely 
Pushing - Rarely 
Reaching - Occasionally 
Reading - Consistently 
Sitting - Consistently 
Standing - Occasionally 
Stooping - Rarely 
Thinking/Reasoning - Consistently 
Use of Hands - Consistently 
Color Vision - Consistently 
Walking – Frequently

TriHealth SERVE Standards and ALWAYS Behaviors

At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following:

Serve: ALWAYS... 
• Welcome everyone by making eye contact, greeting with a smile, and saying "hello" 
• Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist 
• Refrain from using cell phones for personal reasons in public spaces or patient care areas

Excel: ALWAYS... 
• Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met 
• Offer patients and guests priority when waiting (lines, elevators) 
• Work on improving quality, safety, and service

Respect: ALWAYS... 
• Respect cultural and spiritual differences and honor individual preferences. 
• Respect everyone's opinion and contribution, regardless of title/role. 
• Speak positively about my team members and other departments in front of patients and guests.

Value: ALWAYS... 
• Value the time of others by striving to be on time, prepared and actively participating. 
• Pick up trash, ensuring the physical environment is clean and safe. 
• Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.

Engage: ALWAYS... 
• Acknowledge wins and frequently thank team members and others for contributions. 
• Show courtesy and compassion with customers, team members and the community