Professional Billing Representative| Professional Billing

Position: Professional Billing Representative| Professional Billing, Full-Time

Overview

We are looking for a Professional Billing Representative to join our collaborative team at Memorial Health.

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 with various hospital departments to ensure all authorizations, coding and charge information is in place to expedite claims 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, ensures 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
• Addresses dissatisfaction with issues to direct supervisor; actively contributes to the solution of problems and refrains from promoting dissatisfaction among co-workers
• Must be a team player; cooperates 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…