Patient Accounts Billing Representative

Description

Job Title: Patient Accounts Billing Representative

Supervised by: Business Office Director

Job Summary: Responsible for billing and follow up of accounts in the Patient Accounts Department for assigned financial classes, according to documented procedures. A/R activities include but are not limited to:

· Claim status

· Billing/Rebilling claims

· Credit Balance resolution

· Denial Management

· Aged Account follow up and resolution

· Maintaining accurate and up-to-date account information

· Cash posting

Demonstrates Competency in the Following Areas:

• Claim Status – Follow up with payer prior to 35 days from last bill for accurate and complete status of the claim per documented payer and claim follow up procedure.
• Billing/Rebilling claims – Billing and rebilling claims accurately and timely per the payer and hospital-specific billing instructions.
• Credit Balance resolution – Resolving and preparing appropriate paperwork for credit balances per the department credit balance procedures.
• Denial Management – Resolving denied claims within 5 days of denial posting/notification from payer. Notifying management of issues creating unnecessary or excessive denials. Utilizing effective follow up and billing techniques to reduce and prevent denials.
• Aged Account follow up and resolution – Working reports of accounts aged over 90 days monthly to resolve aged account balances per payer and general follow up procedures. Notifying management of issues delaying payment on claims in a timely manner.
• Maintaining accurate and up-to-date account information on system – Following the system and reference procedures to ensure proper account status at all times. Proper adjustment being posted, proper insurance (financial class) assigned, proper account documentation and billing status.
• Cash posting – Posting patient payments, insurance payments, and adjustments.
• Stays informed about changes in Medicare, Medicaid and assigned commercial payers.
• Eligibility and coverage verification – using appropriate systems and procedures to ensure proper coverage on claims and correcting billing data. This includes various reports.

Other Essential Functions:

• Works with other team members effectively.
• Assist other team members with back logs as needed.
• Identifying and assisting in resolving issues affecting accounts receivable.
• Answers the telephone in a polite manner. Communicates information to the appropriate staff.
• Demonstrates the ability to be flexible, organized and function well in stressful situations.
• Maintaining a high level of professionalism in all written or verbal communication.
• Treats patients/families with respect; ensures confidentiality of patient records.
• Maintains a good working relationship within the department and with other departments.
• Maintains a professional working relationship with insurance companies.
• Performs other duties as assigned.
• Ensures documentation meets current standards and policies.
• Supports and maintains a culture of safety and quality.

Professional Requirements:

• Adheres to the dress code; appearance is neat and clean.
• Completes annual educational requirements.
• Maintains regulatory requirements.
• Reports to work on time and as scheduled; completes work within designated time.
• Wears identification while on duty; uses computerized punch time system correctly.
• Attends 12 staff meetings annually; or reads and returns all monthly staff minutes.
• Participates in CQI activities.

Requirements

Regulatory Requirements:

· High school graduate or equivalent.

· Minimum 2 years of Medicare/Commercial billing experience, preferred.

Language Skills:

· Able to communicate effectively in English, both verbally and in writing.

· Additional languages preferred.

Skills:

· Thorough understanding of Medicare, Medicaid, HMOs, PPOs, private insurance companies.

· Basic computer knowledge, Microsoft Excel, data entry skills.

Physical Demands:

· Normal hospital environment. Close eye work. Hearing within normal range. Operates computer, typewriter, copier, calculator, telephone, fax machine, and general office equipment. Continuous sitting. Occasional standing, walking, and bending within the work areas. Minimal lifting up to 40 pounds.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care.