Professional Billing Representative | Professional Billing

Billing Functions: Ensures insurance claims are sent timely and accurately to government, commercial and managed care plans, adhering to payer timely filing requirements.

Researches and resolves claim edits via Epic Work Queues (WQ) and/or external billing software, including electronic and paper processing. Prepares and processes secondary and tertiary insurance claims completing coordination of benefit tables accurately reflecting prior payer reimbursement. Ensures compliance and billing requirements for Worker's Compensation (WC) and third-party liability claims are met.

Ensures claims submission with all appropriate documentation, using the Release of Information (ROI) module in Health Information System (HIS). Verifies and updates patient account demographic and financial information, processing Real-Time Eligibility (RTE); contacting account guarantor and/or payer as appropriate for demographic and financial clarification. Enters complete and appropriate account note(s) in HIS identifying actions taken to reconcile claims. Works various hospital departments to ensure all authorizations, coding and charge information is in place to expedite clams processing and accurate account reimbursement.

Understands Medicare Common Working File (CWF) and how to determine primary payer based on Medicare Secondary Payer Questionnaire (MSPQ). Works in conjunction with various physician offices; providers and managers, to obtain billing and coding information. Accounts Receivable Management: Manages account review and processing from system WQs, insures timely follow-up on all unpaid claims within appropriate billing cycle; manages system denial remark module, taking steps to rectify current denial.

Contacts payers via payer websites and telephone for claim status and/or clarification on denied claims. Manages outstanding accounts receivable per departmental standards; maintains each payer's outstanding receivables at or above departmental established goals. Prepares and submits appeals, collecting all pertinent documentation; filing per each individual payer's guidelines.

Customer Service: Supports all team members and co-workers, engaging in positive interactions at all times. Exhibits professional communication with customers, family members, co-workers, vendors and payers, by providing helpful assistance and responding timely to requests.

Insures active listening prior to responding, remains calm and confident when assisting others. Demonstrates a strong representation of Memorial Health's values through attitude, actions and communications with others. Addresses patient concerns and complaints and provides resolution for readily resolved issues; escalates more in-depth issues as appropriate to assist with service recovery.

Displays enthusiasm while applying quick thinking and resourcefulness in providing assistance. Critical Thinking: Actively looks for and creates opportunities to improve department, staff and personal development.

Develops and demonstrates knowledge of current developments in field to maintain competency. Utilizes hospital and departmental policies and procedures. Interpersonal: Acts as a resource for new employees and precepts as needed.

All interactions are conducted in a professional manner. Demonstrates a positive attitude. Provides excellent customer service, facilitates quality care delivery and fosters an atmosphere of understanding cultural diversity.

Communicates dissatisfaction with issues to direct supervisor; actively contributes to the solution of problems and refrain from promoting dissatisfaction among co-workers. Must be a team player; cooperate with co-workers to resolve conflict through one on one negotiation or with the assistance of the Director or their designee. Maintains confidentiality at all times to protect patient's privacy and maintains HIPAA privacy and security regulations.

Documentation: Documents accurately (painting a complete picture providing directions to other health care providers); refrains from using unapproved abbreviations in written or computer documentation. Documentation is completed on a daily basis. Understands the importance of accurate completion of documentation and Hospital accreditation requirements and how it impacts hospital payment and certification programs.

Education: HIPAA privacy regulations and related procedures. CMS updates on patient rights.

Requirements

High school diploma or equivalent and three (3) years' experience in the medical field preferably in a hospital setting. Knowledge of revenue cycle functions, understanding of health insurance and government programs, billing processes, managed care contracts, coordination of benefits with ability to interpret explanation of benefits desired.

Knowledge of office practices and procedures, medical terminology and the ability to communicate effectively. Must be proficient with Microsoft Word, Excel and PowerPoint.

Shift

1st

Hours

80 per pay (Every two weeks)

Benefits

• Medical Insurance

• Dental Insurance

• Vision Insurance

• Life Insurance

• Flexible Spending Account

Time Off

• Vacation

• Sick Leave

• 11 Paid Holidays

• Personal Day

Retirement

• Ohio Public Employee Retirement System

• Deferred Compensation

Other

• Tuition Reimbursement

• Kidzlink Daycare Center

• Employee Recognition

• Free Parking

• Wellness Center

• Competitive Salaries

• Community/Family Atmosphere