Billing Representative I

The Hospital Billing Representative I is responsible for various tasks in the Accounts Receivables reconciliation process including but not limited to: examining, correcting and consistently updating Patient Health Information to ensure accurate insurance billing/payment/follow-up; submit bills electronically to payers using designated claims software for the corporation; reviewing rejected claims in such billing software to scrub claims and send them clean to the payer to avoid denials; applying appropriate contractual and self-pay adjustments; resolving patient and insurance carrier inquiries; communicate with physician offices, as necessary, to obtain authorizations or notify them of medically unnecessary orders for diagnostics; using on-line systems provided by multiple payers to verify eligibility and benefits and checking claim status; maintain appropriate/ consistent documentation on accounts worked; apply proper account management principals to accounts to ensure accurate billing; identify non-payment trends by payer and notify management; work based on goals set by management for productivity of validated claims being submitted on a daily basis; makes account corrections as necessary to ensure prompt payment of claims, regardless of which department is responsible for obtaining this information; prints and mails medical records and itemized statements as necessary for payers requiring paper claims submissions; if necessary, phones patients or employers to verify health insurance or worker's compensation information in order to submit claims timely and accurately; maintains a high level of professionalism and communication when it comes to working with other areas of the business office or revenue cycle in an effort to submit bills timely and accurately Responsibilities Maintains responsibility for the billing process for patient accounts including but not limited to: examining, correcting and consistently updating patient health insurance claims to ensure prompt insurance payment/follow-up.

Resolves patient and insurance carrier inquiries related to billing for the revenue cycle. Uses on-line systems provided by multiple payers to verify eligibility and benefits and checking claim status appropriately. Makes telephone calls to the payer to inquire about denial trends in billing to ensure claims are sent “clean”.

Maintains appropriate/consistent documentation on accounts worked within the patient accounting systems. Reviews memos on accounts within patient accounting systems for all reprinted or rebilled claims to ensure any necessary updates/changes are made before submission to the payer. Identifies non-payment trends by payer and notifies systems coordinators and management in order to change billing tables to bill accurately or to adjust off timely, to reduce number of A/R days.

Minimum Education High School Diploma or Equivalent Required Minimum Work Experience 6 months relevant revenue cycle experience (patient access, financial assistance, insurance billing, patient and/or insurance collections, reimbursement, customer service, payer contracting, or coding) Required

Full time · Day shift · 40 hours per week