Summary

Performs a variety of routine day-to-day operations related to the administration of billing accounts for a defined University medical service or billing agent.

Duties and Responsibilities

1. Performs daily and monthly reconciliations to the general ledger, to include reclassifications; receives and balances documents of deposits received, and distributes remittance advices.
2. Reviews third-party payer remittance documentation in order to reconcile payments to remittance advices; reconciles and applies changes and corrections to patient invoices and accounts.
3. Prepares adjustment and refund request forms.
4. Researches and prepares billings for initial electronic claims submissions.
5. Posts and receipts payments from patients and third party payers and reconciles input to ledgers and reports.
6. Responds by telephone or correspondence to inquiries from patients/third party payers; explains insurance coverage to patients, researches problems, and corrects errors.
7. Reviews credit balances, refunds, adjustments, and claim denials; reconciles, corrects, and applies adjustments to billing records.
8. Identifies and investigates problem delinquencies; recommends appropriate disposition, such as referral for collection, legal action, or write off.
9. Interprets remittance documents from all third-party payers to ensure appropriate posting and account accuracy.
10. Ensures strict confidentiality of patient medical and financial records, in compliance with federal and state patient privacy legislation.
11. Follows established departmental policies, procedures, and objectives.
12. Performs miscellaneous job-related duties as assigned.

Minimum Job Requirements

• High school diploma or GED; at least 1 year of experience directly related to the duties and responsibilities specified.
• Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.

Knowledge, Skills and Abilities Required

• Knowledge of medical claims procedures and documentation.
• Ability to calculate numbers, correct entries, and post to records.
• Ability to communicate effectively, both orally and in writing.
• Knowledge of personal computers and related medical billing software.
• Ability to maintain confidentiality of records and information.
• Knowledge of payment and collection procedures.
• Knowledge of medical billing procedures.
• Knowledge of medical billing and medical claims procedures.
• Ability to perform numerical calculations, correct entries, and post to records.
• Knowledge of credit and collection principles, processes, regulations, and standards.

Distinguishing Characteristics

Position requires: a) performance of routine, periodical ledger maintenance, adjustments, and reconciliations b) review of third party payer remittances and reconciliation of payments to remittance advices; c) posting and receipting payments from patients and third party payers; d) routine response and advisement to patient/third party inquiries; e) performance of routine adjustments to billing records and referral of problems and delinquencies.

Working Conditions and Physical Effort

• No or very limited physical effort required.
• No or very limited exposure to physical risk.
• Work is normally performed in a typical interior/office work environment.

The University of New Mexico provides all training required by OSHA to ensure employee safety.

Revised Date: 03/20/2017