The Accounts Receivable Billing Rep is responsible for accurate and prompt follow-up of unpaid or denied claims/charges. Rep is also responsible for providing outstanding customer service to both patients and staff members. Rep must be able to research difficult accounts and report any specific denial trends to management. Rep will be responsible for staying current with all assigned payer updates.
Thorough knowledge and understanding of patient billing, billing transmission and electronic billing systems, including reimbursement knowledge of Medicare, Blue Cross, United Health Care, Medicaid, commercial insurance and HMO carriers
Knowledge of medical terminology and ICD-9/CPT coding. Demonstrate competency in coding CPT and ICD9 related to reimbursement
Strong written and oral communication skills including the ability to work with other departments. Demonstrate positive interpersonal relations in dealing with fellow employees, Supervisors, Physicians, Management so that productivity and positive employee relations are maximized
Ability to interpret third party coverage, patient responsibility and evaluate a patient's financial condition
Knowledge of processes for billing professional services provided in the hospital and office setting. Knowledge of the appeals processes for different payers.
Knowledge of electronic billing systems and EMR's
Ability to work and resolve problems independently and demonstrate task completion
Demonstrate thorough knowledge and understanding of CBO Policies and Procedures as well as the NGHS handbook
Demonstrate thorough understanding of Medicare and commercial waivers if pertinent to job
Demonstrate competency in use and maintenance of computer equipment, printers, and telephone system and facsimile machines. Understand basic PC window applications.
Maintains current knowledge of third party, federal and state regulations, insurance coverage, rejection codes and billing requirements related to physician billing and follow-up. This is to be accomplished by attending related seminars, research, meeting with insurance reps and reading all memos/payer updates.
Ensures secondary billing on accounts with secondary liability; follow-up on any unpaid balances.
Provides corrected data and resubmit claims as necessary.
Responds to patient and third party inquiries/complaints regarding patient accounts via telephone, mail or in person.
Maintains/improves productive third party relationships.
Ensures that denied visits/services are appealed or processed to be written off if applicable.
Reports possible write-offs to Practice/Billing Manager.
Works closely with other billing personnel and Practice/Billing Manager in following up on accounts.
Works closely with other billing personnel and Practice/Billing Manager in following up on accounts.
Reviews/analyzes patient accounts and take needed actions to resolve patient issues by executing adjustments, refunds, etc. from incoming/outgoing telephone calls or mail.
Provides the highest-level customer service to patients and other CBO or center staff by following through on phone calls, site questions/concerns and account inquiries. Resolve patient complaints and requests regarding insurance billing and initiate accurate account adjustments.
Updates demographic and insurance information on patient accounts as needed.
Keeps others in Central Business Office informed of third party billing updates, documentation guidelines, and reimbursement/ contract administration.
Serves as a liaison with payers, collection agencies and patients by being available to answer questions, handle situations as they occur and meet with insurance reps regularly.
Follows all billing problems to conclusion.
Resubmits insurance claims as required.
Ensures the integrity and timeliness of workflow by making sure work is turned in as assigned as well as follow-up on the progress and documentation of account load.
Collects and review all patient insurance information needed to complete the billing process.
Completes all necessary insurance forms (i.e. HCFA 1500) to process the proper billing information in a timely manner as required by all third party payers.
Submits all paper claims and supporting documentation as required by payers.
Works CBO reports in a timely manner and turn in to Supervisor/Manager on designated dates. Reports must be completed along with putting notes in the system, follow-up as needed and awareness to reducing the over 90 (+) days aging buckets.
Reports any problem, concerns, trends or issues with Supervisor/Manager by monitoring accounts.
Maintains updated resource manuals and related materials.
Ensures integrity, confidentiality and security of patient records.
Assists center Practice Administrators in reimbursement issues.
Helps to maintain overall cleanliness and safety of workplace in the business office.
Promotes excellence in patient relations and customer service, emphasizing compassion, responsiveness, respect and courtesy.
Reviews credit balance and overpaid insurance reports as assigned. Identifies sources of overpayment and ensures appropriate refund processing or account correction.
Researches all credit balance accounts and identifies source(s) of overpayment.
Enters refund transaction detail into appropriate system to accurately reflect approved transaction.
Asks questions to determine patient needs.
Uses active listening skills, getting information and summarizing to check understanding.
Looks for opportunities to exceed patient's expectations by acting promptly, involving patient where solutions are needed.
Confirms patient's satisfaction with service or course of action, and commit to follow-through.
Works harmoniously with others, demonstrating a commitment to achieving common goals.
Responds positively to work-related requests from others.
Communicates in a manner that promotes trust and mutual respect.