Northwest Michigan Works!

On-the-job Training

• OJT/Task/Competency
  • Obtain referrals and pre-authorizations as required for procedures and office visits
  • Review documentation for medical necessity based on payer criteria
  • Check eligibility and benefits verification for treatments and procedures
  • Review accuracy of insurance information loaded by front desk/pre-registration staff
  • Prepare cost estimates for upcoming procedures
  • Demonstrate basic understanding of CPT, ICD-10 and HCPCS codes
  • Review patients bill for accuracy and completeness, and obtain and missing information
  • Prepare, review and transmit claims using billing software, including electronic and paper claim
  • Follow up on unpaid claims within standard billing cycle timeframe
  • Check each insurance payment for accuracy and compliance with contract discount
  • Call insurance companies regarding any discrepancy in payment if necessary
  • Identify and bill secondary or tertiary insurances
  • Review counts for insurance and patient follow-up
  • Research and appeal denied claims
  • Answer all patient or insurance telephone or email inquiries pertaining to assigned accounts
  • Answer staff questions regarding coverage/cost for various service
  • Update billing software with fee schedule, reimbursement and RVU charges
  • Update CPT, ICD-10 and HCPCS yearly within billing software
  • Update cash spreadsheet and run collection reports
  • Maintain files within PM system for payers and ensure correct edits, claim process rules, etc. are applied
  • Prepare and review various AR reports
  • Apply Incident - To status to claims per payer rules
  • Understand billing guidelines (modifier requirements, claim filing limit, order of priority, etc.) for government payers (Medicare, Medicaid, Tricare, VA, etc.)
  • Understand billing guidelines (modifier requirements, claim filing limits, order of priority, etc.) for commercial payers (BCBX, Priority Health, Aetna, Cigna, United Healthcare)
  • Understand billing guidelines (modifier requirements, claim filing limits, order of priority etc.) for worker's compensation and automobile accident (PIP)
  • Understand overpayment/refund processes for various payers as well as how to post refunds/overpayment recoupment in system
  • Access CAQH and other credentialing platforms for new providers and updates
  • Collect various provider identifiers including NPI, Tax ID, PTAN, State License and DEA numbers for new providers
  • Obtain and maintain access to various payer websites
  • Use 3rd party software integration with PM system for payment plans, email payment reminders, etc. and understand how to coincide
  • Process overdue patient accounts to bad debt/3rd party collection agency
• Participating Employer - Behavioral Competencies
  • Participation in team discussions/meetings
  • Focus in team discussions/meetings
  • Focus during independent work
  • Openness to new ideas and change
  • Ability to deal with ambiguity by exploring, asking questions
  • Knows when to ask for help
  • Able to demonstrate effective group presentation skills
  • Able to demonstrate effective one-on-one communication
  • Maintains an acceptable attendance record
  • Reports to work on time
  • Completes assigned tasks on time
  • Uses appropriate language
  • Demonstrates respect for patients, co-workers and supervisors
  • Demonstrates trust, honesty and integrity
  • Requests and performs work assignments without prompting
  • Appropriately cares for personal dress, grooming and hygiene
  • Maintains a positive attitude
  • Cooperates with and assists co-workers
  • Follows instructions/directions
  • Able to work under supervision
  • Able to accept constructive feedback and criticism
  • Able to follow safety rules
  • Able to take care of equipment and workplace
  • Able to keep work area neat and clean
  • Able to meet supervisor's work standards
  • Able to not let personal life interfere with work
  • Adheres to work policies/rules/regulations