GENERAL CLASS DESCRIPTION:
Under general supervision, performs and coordinates specialized work requiring
a knowledge of specialized subject matter including policies and procedures
of multiple third party payors including third party provider profile reimbursements,
appropriate use of CPT IV codings and knowledge of federal regulations
regarding covered and non-covered codes. Needs working knowledge of State
of Iowa Indigent Care Program, Medically Needy and other assistance programs
as well as research grants and Clinical Research programs providing reimbursement
for Hospital and/or Medical Service physician fees. Maintains records in
patient accounting files requiring manual logs and on-line functions for
submission of third party payors and recording receivables; initiates transfers,
cancellations, audit adjusts and verification of charges to patient accounts;
and reviews all accounts for self pay billing and performs appropriate
on-line function to release or hold patient statements. In addition, all
information is provided to patients and payors as needed. Duties may involve
the use of personal computers, computer terminals, and a variety of software
and/or conventional office equipment.
CHARACTERISTIC DUTIES AND RESPONSIBILITIES:
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Prepares, reviews and analyzes billing control lists, hard copy billing
documents for hospital inpatient and outpatient charges as well as all
professional fees for all procedures performed, and on-line patient account
records which requires independent informational search and a knowledge
of the policies and procedures of both assigned and related work areas
as well as policies and procedures of third party payors.
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Advises third party payors, patients and others concerning policies and
regulations in the assigned work areas.
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Initiates standardized forms and on-line functions related to the area
of assignment.
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Composes correspondence requiring judgment in the application of policies
and procedures in both the assigned and related work areas.
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Reviews and investigates verbal and written inquiries regarding policies
and procedures of submissions to third party payors and self pay billing
requiring knowledge of assigned and related work areas. Reviews medical
record documents and provides additional documentation for claim processing
when appropriate authorizations are verified.
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Reviews accounts to insure each "Usual and Customary" (UCR), non-allowable
and courtesy discount entry is computed correctly or appropriate adjustments
are made for both hospital and professional fees.
The tasks listed under the heading of Characteristic Duties
and Responsibilities are examples of the variety and general nature of
duties performed by employees in positions allocated in the class. The
list is descriptive only and should be used for no other purpose. It is
not intended that any position include every duty listed nor is it intended
that related duties cannot be required.
KNOWLEDGES, SKILLS, AND ABILITIES:
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Knowledge of medical reimbursement policies and procedures.
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Skill in using office equipment.
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Ability to communicate effectively with staff, students, and the public.
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Ability to follow oral and written instructions and interpret institutional
and other policies accurately.
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Ability to make decisions requiring interpretation and judgment.
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Ability to gather, analyze, and display data in appropriate format and
keep accurate records.
CLASS SPECIFICATIONS:
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Clerical office experience which is equivalent of three years of full-time
employment, of which at least twelve months must be comparable to or above
the level of Clerk II, or at least six months previous experience in the
Hospital Business Office at the level of Clerk III, or
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Any combination of clerical office experience and undergraduate college
level course work or post high school secretarial/clerical training that
is the equivalent of four years of full-time employment and includes at
least twelve months of clerical office experience comparable to or above
the level of Clerk II; study as a full-time student may be substituted
for work experience on a month-for-month basis for a maximum of 30 of 36
required months of experience.
REVISION EFFECTIVE: October 1, 1997
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