Patient Billing Rep I

About Methodist

Nebraska Methodist Health System is made up of four hospitals in Nebraska and southwest Iowa, more than 30 clinic locations, a nursing and allied health college, and a medical supply distributorship and central laundry facility. From the day Methodist Hospital was chartered in 1891, service to our communities has been a top priority. Financial assistance, health education, outreach to our diverse communities and populations, and other community benefit activities have always been central to our mission.

Job Summary

Location: Methodist Corporate Office, 825 S 169th St. - Omaha, NE. Responsible for billing, electronic claims submission, follow up and collections of patient accounts.

Responsibilities

• Submit electronic and hardcopy billing claims, including EDI and paper claims, following department and payer specific guidelines.
• Obtain appropriate EOBs through use of health system resources.
• Review Billing Scrubber Claim Detail Screens to ensure data is appropriate for claim submission.
• Ensure that claim corrections identified in billing scrubber are appropriately updated and documented in Source System.
• Prepare secondary and tertiary billings, manually and electronically on UB04s and/or 1500s for accurate reimbursement.
• Submit adjusted UB04/837I and/or CMS1500/837P claims according to department and payer specific guidelines.
• Display effective communication skills, including active listening, notifying leads and supervisors of identified issues, and following telephone etiquette procedures.
• Provide professional and courteous responses when communicating with customers, health system staff, and management.
• Handle referrals timely and accurately, including escalated priority referrals from management, within department guidelines.
• Document all referrals and patient inquiries clearly in the Source System when necessary, and follow up with patients on final results both timely and professionally.
• Demonstrate ability to learn and maintain a working knowledge of all current health system applications.
• Identify, obtain, and print medical records as necessary for resolution of denials or system edits according to department guidelines.
• Audit patient accounts using accounting and business principles to accurately determine remaining balances on encounters.
• Update proration to allocate dollars to appropriate benefit orders when needed.
• Leverage all needed resources to complete account audits and document findings in Source System.
• Conduct claim follow up with third party payers, including understanding billing and follow up processes, contract requirements, and using payer websites and tools.
• Interpret correspondence assigned for accurate handling.
• Complete special projects and assigned tasks timely, accurately, and to leadership specifications.
• Ensure daily, weekly, and monthly assignments are handled accurately and timely.
• Manage and maintain assigned workflow queues according to department guidelines.
• Process and handle mail and correspondence following departmental guidelines.
• Document timely and appropriately in Source System using proper documentation methods.
• Maintain fundamental understanding of different work item, state based, and exception queues within Patient Accounting System applications.

Requirements

• High school diploma, GED, or equivalent required.
• Coursework in Coding, Billing, or Healthcare Management through a secondary education institution or online classes through AHIMA preferred.
• Minimum of one (1) year prior experience in healthcare third party billing and/or claims processing preferred.
• Prior exposure to UB04 and/or CMS1500 claim data through work in a physician's office or other healthcare setting preferred.

Skills & Abilities

• Skill in interpreting UB04 and/or CMS1500 claim data to troubleshoot claim edits and resolve payer billing requirements timely and accurately.
• Ability to create and submit both original and corrected claims.
• Ability to audit accounts and payer explanation of benefits (EOBs) to determine appropriate action.
• Ability to use effective communication skills to handle patient inquiries, attorneys, health system staff, and payers on a professional level.
• Knowledge and understanding of accounting and business principles to enable accurate auditing of patient accounts.
• Ability to follow up with third party payers for claims and appeals submitted to ensure timely and accurate processing.
• Ability to maintain a working knowledge of multiple system applications.

Work Schedule

Monday - Friday, 7:00am to 3:30pm.

Physical Requirements

Weight Demands: Light Work - Exerting up to 20 pounds of force.

Physical Activity - Occasionally Performed (1%-33%): Balancing, Climbing, Carrying, Crawling, Crouching, Distinguish colors, Kneeling, Lifting, Pulling/Pushing, Reaching, Standing, Stooping/bending, Twisting, Walking.

Physical Activity - Frequently Performed (34%-66%): Hearing, Repetitive Motions, Seeing/Visual, Speaking/talking.

Physical Activity - Constantly Performed (67%-100%): Fingering/Touching, Grasping, Keyboarding/typing, Sitting.

Job Hazards - Rare (1-33%): Chemical agents (Toxic, Corrosive, Flammable, Latex), Mechanical moving parts/vibrations.

Job Hazards - Not Related: Biological agents (primary airborne and bloodborne viruses - jobs with patient contact), Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps - more than ordinary office environment), Equipment/Machinery/Tools, Explosives (pressurized gas), Electrical Shock/Static, Radiation Alpha/Beta/Gamma, Radiation Non-Ionizing.