Job description

Job Description
This position is responsible for accurate and timely billing of assigned accounts, along with the follow-up of these accounts to ensure prompt payment. Responsibilities also include staying current with all Payer rules and regulations to ensure proper billing and compliance. The representative is responsible for prompt follow-up with third party payors and maintaining quality standards. The individual pursues and ensures timely and accurate expected reimbursement collection for the hospital, interpreting managed care contracts and holding payors accountable to contract standards.

Demonstrate respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background.

Job Duties

Follow-Up Responsibilities:

• Call insurance or use online payer portals for status on claims
• Records appropriately detailed notes in Epic.
• Takes appropriate action to resolve claims: write disputes, communicates with supervisor/lead.
• Coordinates and provides feedback in payer meetings to discuss payer trends and issues.
• Meets productivity and quality standards.
• Demonstrates excellent customer service skills when interacting with patients to resolve claim issues (i.e. COB, Accident Details).
• Demonstrates adequate, appropriate, and professional levels of communication with insurance company representatives, team members, supervisors, and managers.
• Collaborates with Technical Denials Specialists to track, trend, and resolve claim issues.
• Work insurance correspondence and inbound faxes timely and makes the necessary responses to the letters received.
• Ensures timely turnaround of internal requests (EOB’s, medical records) through effective follow-up
• Elevates serious barriers to claim resolution to the leadership team

Billing Responsibilities

• Reviews bills and related information for accuracy and reasonableness of charges.
• Work specific reports, as required for the payer(s).
• Submits bills to payers electronically or by paper
• Proficient in Government and Commercial payers regulations and reimbursement policies
• Proficient in Government and Commercial payers contractual agreements and regulations to apply requirements for accurate billing and to make recommendations for system changes as needed
• Computes required adjustments to bills, balances to support, and inputs debits/credits to billing system to appropriate codes to ensure accurate billing.
• Follows up on insurance requests for medical records, COB, accident information, bundling issues, policy related restrictions, DRG downgrades, and using proper managed care tools for DRG calculations.

Other

• Completes special projects & tasks by the established time frame.
• Proactively notifies lead and supervisor of any barriers that prohibit billing and/or payment of claims.
• Completes other tasks and duties as assigned by leadership
• Assists co-worker in problem solving, with reports and work lists, meetings, etc.
• Execute training of contracted staff (internal and external).
• Act as a preceptor for new employees and as a resource within the department/division.

Communication/Trending

• Trends weekly productivity through defects, manual adds, and correspondence goals.
• Attends department meetings and huddles.
• Attends and participates payer meetings.
• Identifies payer and billing issues, which would help avoid denials.

Continuing Education & Training

• Seeks opportunity for training and informs lead/supervisor of all training needs
• Attends seminars and workshops as assigned by leadership, to obtain billing, follow-up, and/or denial avoidance information related to specific payers.

Perform other duties as assigned
Qualifications

Education, Credentials, Licenses:

• High school diploma

Specialized Knowledge:

• Customer Service Skills
• Excellent Communication Skills
• Problem solving skills

Kind and Length of Experience:

• One year of hospital Revenue Cycle or Patient Access

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