Billing/Patient Accounts Rep

Reports to Patient Accounts Manager. Performs a variety of duties related to the billing of patient accounts. Submits appropriate claim forms, electronic billing, maintaining the insurance file master, payment posting, and daily balancing.

MISSION, VALUES and SERVICE GOALS

• MISSION: We deliver outstanding care, inspire health, and connect with heart.
• VALUES: Trust. Respect. Integrity. Compassion.
• SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Audit Process

• Reviews patient accounts data including demographic patient/guarantor information, insurance information, and appropriateness of charges.
• Communicates identified problems to appropriate supervisory personnel and participates in appropriate corrective action.
• Ensures all appropriate documentation, including but not limited to, updated addresses, account notes, etc. has been entered into the Patient Accounting system for future reference.

Billing/Electronic Claims

• Enters correct patient account data to impact the production of an accurate and appropriate UB-04 or CMS1500 claim form.
• Ensures proper conformance with established government and third-party processing standards by working all edit errors to ensure clean claims are submitted to payers.
• Corrects any errors in charging and/or insurance data to facilitate submission of a clean claim.
• Submits and/or mails accurate and complete UB04 or CMS1500 claim forms to patients/guarantors and various government and third-party payors in a timely manner.
• Demonstrates ability to submit primary governmental and commercial claims electronically daily. Ensure that status of claims and the billing secondary claims are submitted in an accurate manner.

Follow-up

• Completes prompt follow-up of outstanding governmental receivables and takes appropriate action to ensure timely reimbursement.
• Audits paylist weekly to ensure denied claims, due to inaccurate information, have been corrected and rebilled in a timely manner.
• Works with patients and/or family member to ensure timely payments.
• Keeps abreast of changes in policies, procedures, regulations and requirements of the governmental payor.
• Request, prepares and submits necessary documents required for payment including but not limited to prior authorizations, consent forms and letter of non-coverage.

Communications

• Demonstrates good interpersonal skills by communicating with customers, patients, physicians, co-workers and other departments in a friendly, caring, sincere and cooperative manner.
• Communicates with internal and external departments or agencies in order to provide or obtain information to resolve outstanding governmental patient receivables.
• Contribute to the overall effectiveness of the department
• Completes other job-related duties and projects as assigned.

ORGANIZATIONAL RESPONSIBILITIES

Associate complies with the following organizational requirements:

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established timeframes.
• Completes annual employee health requirements within established timeframes.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

• Leverage innovation everywhere.
• Cultivate human talent.
• Embrace performance improvement.
• Build greatness through accountability.
• Use information to improve and advance.
• Communicate clearly and continuously.

Education and Experience

• The knowledge, skills, and abilities as indicated below are normally acquired through the successful completion of a High School Diploma or Equivalent. No previous experience is required.

Knowledge & Skills

• Demonstrated technical knowledge of the UB04 and CMS1500 claim form and its use and application for government billings.
• Demonstrated technical knowledge of government agency policies, procedures, regulations and requirements.
• Organizational skills necessary to manage and control automated and manual billings and follow-up.

Working Conditions

• Prolonged exposure to computer terminals.

Physical Demands

• Occasional lifting of storage boxes weighing up to 50 pounds when filled with completed forms.