Patient Billing Representative Job at Memorial Hospital and Health Care
Job Summary
Under general supervision, bill all patient accounts to third party payors in a manner consistent with the Mission Statement of Memorial Hospital & Health Care Center for all patients bills (age ranging from birth to maturity).
Qualifications
Education:
High School graduate required
Under general supervision, bill all patient accounts to third party payors in a manner consistent with the Mission Statement of Memorial Hospital & Health Care Center for all patients bills (age ranging from birth to maturity).
Qualifications
Education:
High School graduate required
Training:
Three to six months on-the-job training required
Three to six months on-the-job training required
Experience:
One to three years of billing experience in a hospital or physician office setting required.
One to three years of billing experience in a hospital or physician office setting required.
Job Knowledge, Skills and Abilities:
Ability to make routine decisions following established policy and procedures; Knowledge of Medicare, Medicaid, and health insurance regulations and laws; Knowledge of computers and related functions.
Performance Requirements
Responsible for:
Bills all claims to third party payers; bills secondary insurance as requested, re-bills and follow-up with inquiry on rejected claims, charges and overpayments to ensure appropriate adjudication by payers, maximum plan payment from the payer, reimburse payer overpayments when appropriate, determines status of account at the point of insurance payment.
Ability to make routine decisions following established policy and procedures; Knowledge of Medicare, Medicaid, and health insurance regulations and laws; Knowledge of computers and related functions.
Performance Requirements
Responsible for:
Bills all claims to third party payers; bills secondary insurance as requested, re-bills and follow-up with inquiry on rejected claims, charges and overpayments to ensure appropriate adjudication by payers, maximum plan payment from the payer, reimburse payer overpayments when appropriate, determines status of account at the point of insurance payment.
Physical Demands:
Sits most of time, as job duties are desk oriented; standing and walking are minimum; manual dexterity needed for handling office and computer equipment.
Sits most of time, as job duties are desk oriented; standing and walking are minimum; manual dexterity needed for handling office and computer equipment.
Special Demands:
Reflects the mission, philosophy, core values and customer service plan of Memorial Hospital and Health Care Center in action and attitude. Willingness and ability to adapt work schedule to meet the demands of the department; exercises tact and patience in communicating with patients, families, physicians, and other personnel.
Representative Functions
Recognize and practice the core values of Memorial Hospital and Health Care Center. (On-going)
Reflects the mission, philosophy, core values and customer service plan of Memorial Hospital and Health Care Center in action and attitude. Willingness and ability to adapt work schedule to meet the demands of the department; exercises tact and patience in communicating with patients, families, physicians, and other personnel.
Representative Functions
Recognize and practice the core values of Memorial Hospital and Health Care Center. (On-going)
Complies with the 5-Step Customer Service Plan as outlined in the Organizational Policy Manual. (On-going)
1. Follow-up on Unpaid Accounts in a Timely Manner (30%)
adjustment billing, appeal processes, refunding overpayments to
third party payers as well patient overpayments.
- Utilizes Computer System to demand Aged Trial Balance Reports
adjustment billing, appeal processes, refunding overpayments to
third party payers as well patient overpayments.
- Understands and utilizes the on-line Work lists for Collection follow-up on accounts.
- Completes and returns Medicare Development letters, Medicaid Claim Correction forms, or other insurance questionnaires and/or correspondence in a timely manner to ensure expedient reimbursement of claim.
2. Rebill All Rejected Insurance Claims (5%)
- Reviews Medicare, Medicaid, Blue Cross, Contract payers & all other third party xpayers EOB's to determine specific rejections and necessity for rebilling.
- Makes necessary corrections to claim and resubmits via paper or electronic transmission to clearinghouse.
- Possesses computer skills for billing edits.
3. Telephone Calls Assist Customers with Inquiries and Complaints (10%)
- Answers all incoming phone calls in an efficient manner
- Picks up phone call immediately
- Answers questions to patient satisfaction
- Screens phone calls for the most efficient & appropriate handling.
4. Requests Additional Information from Other Departments as needed for the payment of the claim. (5%)
- Reviews claim for incomplete and missing information
- Utilizes HIS on-line UB92editor, claim account inquiry options, scanned insurance ID cards, scanned documents to determine clean billing information on the claim.
- Contacts other hospital ancillary departments to obtain necessary
5. Keep Updated on Medicare, Medicaid, and Health Insurance Regulations and changes. (On-going)
- Consistently utilizes all resources for education & follow-up in insurance rules and changes.
- Utilizes the Internet for insurance bullits, updates, changes etc.
- Understands how to look up and use manuals to ensure proper billing procedures.
- Attends educational seminars & workshops to keep updated on current billing/coding changes.
- Regularly attends staff meetings where insurance updates are discussed.
6. Mails Electronic and Paper Claims to Third Party Payors Daily (40%)
- Reviews all new electronic & paper claims daily for electronic or paper errors.
- Daily reviews all electronic payer claims and corrects claim errors based on payer edits.
- Bills are reviewed and corrected timely based on the department time goal for billing completion
- Transmits electronic claims timely via software vendor on a daily basis based on departmental time guidelines.
- Manually mails daily out all non-electronic paper claims to non-electronic payers.
7. Contacts Insurance Companies to Verify coverage, Initiate Pre-certification as needed, and obtain current Insurance Benefits (3%)
- Understands & performs insurance verifications and pre-certifications procedures
- Documents benefit information via telephone, website and/or fax with insurance companies on a daily basis based on established procedures.
- Refers pre-cert issues to Utilization Review for follow up.
8. Bills All Secondary Insurance Claims as Requested (7 %)
- Pulls UB92's & 1500 paper claim forms and submits with primary payer EOB for claim processing to the secondary payer(s).
9. Participates and Commits to Cross-training in Patient Account assignments as requested. (On-going)
- Demonstrates assertiveness and volunteers to learn other departmental job functions as assigned.
- Cross-trained to perform critical departmental functions in the absence of a co-worker.
- Shows assertiveness and initiative in assuring that critical areas are covered.
- Keeps Supervisor updated on any and all issues relating to critical coverage.
10. Bad Debt Resolution (On-going)
- Demonstrates knowledge and expertise in resolution of accounts to a zero balance within a 90 day period of time.
- Reviews new and aging accounts to determine balance due and takes action immediately.
- Contacts insurance companies, physicians offices, patient/family, etc. to determine correct demographic and insurance information when claim has not been paid promptly.
- Maintains over 90 days billed aging accounts to under 15% of total billed AR.
- Immediately works accounts referred by supervisor for follow-up and reports back to supervisor with action.
- Ensures that all options in obtaining information and payment on the account have been exhausted before referring to the Financial Representative.
- Understands when to refer an aging account to a Financial Representative for self pay follow-up with the patient.
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