Patient Accounting - Biller/Rep-PFR

Description

Responsible for the insurance billing process between the hospital and insurance companies, federal agencies, and third-party payers. Audits patient accounts to ensure procedure, charges and coding accuracy. Collects payments from commercial insurance companies, state and federal agencies. Answers patient payment questions and is responsible for resolution of patient complaints, inquiries and billing adjustments if necessary. Participates in performance improvement and continuous quality improvement (CQI) activities.

Required to work on-site

Requirements

QUALIFICATIONS

• Must be a high school graduate or equivalent.

• One to two years of previous hospital patient accounting and/or insurance experience preferred.

ROLES AND RESPONSIBILITIES

• Check all daily accounts for accuracy before forwarding bills to insurance companies.

• Separates accounts by billing groups and works edits on a daily basis.

• Knowledge of HMOs, PPOs, Medicare, Medicaid and Revenue, CPT, HCPCS and ICD-9 coding as it relates to position objective and be current on all billing changes.

• Files insurance claims with appropriate company through the claim scrubber software.

• Maintains a professional working relationship with the insurance companies, government agencies and third-party payers.

• Works independently to resolve account problems.

• Documents all correspondence and conversations with insurance companies, governmental agencies, third party payers and patients on patient accounts.

• Explains all patient charges as required or requests assistance from other departments as needed.

• Answer patient questions in regards to bills and set up payment arrangements.

• Interacts with patients/families in a professional manner; ensures confidentiality of patient records.

• Maintains a good working relationship within the department and with other departments of the hospital.

• Responsible for reviewing, monitoring, and resolving unbilled and/or billed accounts accurately and efficiently.

• Adherence to all state and federally mandated documentation standards.

• Initiates follow-up unpaid accounts that are 30 days or more on a daily basis.

• Prepares on a quarterly basis Medicare’s credit report.

• Knowledge of all third party and government payer requirements.

• Understands Denial Process, resolves denials appropriate.

• Interprets Payer Contracts.

• Comprehensive knowledge of Hospital Billing Office operations/patient accounting-including billing, collections, month end closing processes.

• Answers and trains billers in job functions and/or changes in billing practices.

• Investigates trends in denials, department billing and/or payment in regards to billing.

• Communicates to the Business Office Manager those accounts that need to be sent to the collection agency after all collection efforts have been exhausted by the hospital.

• Supports and maintains a culture of safety and quality.

REQUIREMENTS

• Support CMH’s mission, vision, core values and customer service philosophy

• Adhere to the CMH Compliance Program

• Assures/maintains compliance with all accreditation, statutory and regulatory standards at the local, state, and federal levels

• Comply with all organizational policies.

• Demonstrate outstanding customer service/advocacy, professionalism and integrity

KNOWLEDGE, SKILLS, AND ABILITIES

• Strong organizational and interpersonal skills including the ability to communicate effectively, both orally and in writing

• Medical terminology utilized in medical billings.

• Current office practices and procedures

• Use of standard office equipment

• Proficiency with computer skills including Microsoft Office applications.

PHYSICAL REQUIREMENTS AND ENVIRONMENTAL CONDITIONS

• High-stress environment

• Exposure to blood and body fluids, communicable diseases, chemicals, radiation, and repetitive motions

• Position requires light lifting of 11-20 pounds.

• Position requires reaching, bending, stooping, and handling objects with hands and/or fingers, talking and/or hearing, and seeing

• Mental demands include: alertness, analytic ability, memory, concentration, judgment, initiative, precision, creativity and communication.