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Job Title Billing Specialist
Location Care Ambulance of California
Department Billing / Collections
FLSA Status Non-Exempt
Reports to Pre-Bill Supervisor
Shifts hiring Full-time


Position Title:

Verification Representative

Pay Status/FLSA Code:

Non-Exempt

Reports To:

Prebill Supervisor

Job Code/Grade:

 

Job Family:

Billing

Reviewed & Updated:

 03/03/2016

Position Summary:

The Verifier is responsible for managing a large caseload of electronic Patient Care Reports in a timely, organized and efficient manner. This position will be accountable for accurate review of patient accounts, verification of insurance information provided on electronic Patient Care Reports and data entry of patient demographic information.

Productivity Standard:

Non-emergency transports – The verifier will be responsible for processing a minimum of 350 ePCR’s per week. To reach this quota, an average of 70 tickets per day must be maintained which requires you to complete approximately 8.75 tickets per hour.

 

Emergency transports – The verifier will be responsible for processing a minimum of 250 ePCR’s per week. To reach this quota, an average of 50 tickets per day must be maintained, which requires you to complete approximately 6.25 tickets per hour.

 

Falck Northern California transports – The verifier will be responsible for processing a minimum of 280 ePCR’s per week. To reach this quota, an average of 56 tickets per day must be maintained which requires you to complete approximately 7 tickets per hour

 

Any errors made during this process will be tracked and monitored. For every two (2) errors made by the Verifier, one (1) strike will be given against the total daily quota. To meet the requirements of this position, the weekly quota must be met in a consistent and routine manner. There may not be more than 1 deficiency within any given 6 week increment of time. 

Requirements:

  • At times, mandatory overtime may be required with short notice.
  • Employee is accountable for proper time management as related to productivity and recording daily schedules.

Essential Functions:

The Verification Representative may be assigned one or more duties. These duties may include, but are not limited to, the following: 

  • Access appropriate workflows to locate ePCR
  • Review CAD and screen for documentation of special billing instructions
  • Review ePCR for insurance information, medical necessity and other pertinent information as related to billing
  • Verify insurance information via online resources, as well as by telephone
  • Navigate through Paperclip to locate supporting documentation that may be relative to the billing process (i.e. PCS)
  • Attempt to initiate contact with patients when insurance information is not provided at the time of service
  • Skip trace using online tools and resources
  • Have knowledge of how to identify MVA and WC related transports
  • Data entry of patient demographics
  • Select and add appropriate payor to patient accounts
  • Understand signature requirements and have the ability to recognize valid vs. invalid signature types
  • Recognize and identify appropriate level of service (ALS vs. CCT, etc.)
  • Knowledge of ICD-9 and HCPCS codes, as well as associated modifiers
  • Other duties as assigned by Billing Manager

Qualifications:

To perform this job successfully, an individual must be able to adequately perform each essential duty. The requirements listed below are representative of the knowledge, skills, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The individual in this position must possess the following qualifications:

                    

  • High School Diploma and/or two years of Medical Billing and Collection experience.
  • Ability to demonstrate proper time management skills as related to daily schedules and productivity.
  • Aptitude for appropriate use of a time keeping system.
  • Must be computer literate.
  • Skilled in data entry.
  • Ability to type a minimum of 45 wpm.
  • Must have knowledge of medical terminology.
  • Excellent interpersonal and customer service skills.
  • Ability to communicate, both orally and in writing, in a professional manner when dealing with employees and management.
  • Ability to work independently of direct supervision.
  • Well organized and detail oriented.
  • Display a willingness to work as a team player.
  • ·         Ability to handle multiple tasks and to prioritize their importance.         

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to use hands to handle or feel objects, keyboards, or phones, reach with hands and arms, and talk or hear. The employee is primarily required to sit and type. The employee is occasionally required to stand or walk. The employee must occasionally lift and/or move up to 5 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Environmental Conditions:

Except where appropriate and conducive to accomplishing the goals and objectives of a particular task (such as in an emergency situation) the Verification Representative will work in a well-lighted area that is ventilated and is as physically and psychologically innocuous as possible under the conditions which exist at a particular time. To be qualified for the position of Verification Representative, an applicant or employee will have the ability to work in an environment conducive to allowing high productivity, with reasonable accommodation and without posing a direct threat to self or others. The noise level in the work environment is quiet to moderate.

The statements in this document are intended to describe the general nature and level of work performed by individuals assigned to the classification.  They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.  This document in no way constitutes a contract of employment.  Care Ambulance Service reserves the right to modify job descriptions, policies or any other procedural documents at any time, for any reason without prior notice. 

 


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