Patient Billing Rep II

About the Role

Responsible for billing, electronic claims submission, follow up and collections of patient accounts.

Work Schedule

Monday – Friday; daytime business office hours

Location

Methodist Corporate Office, 825 S 169th St., Omaha, NE

Essential Functions

• UB04/837I and CMS1500/837P Claim Edit Handling/Billing/Interpretation
  • All EDI and paper claims submitted are to be billed as needed following department and payer specific guidelines.
  • Obtains appropriate EOBs through use of health system resources.
  • Reviews Billing Scrubber Claim Detail Screens to ensure data is appropriate for claim submission.
  • Ensures that claim corrections identified in billing scrubber are appropriately updated and documented in Source System.
  • Prepares secondary and tertiary billings, manually and electronically on UB04s and/or 1500s for accurate reimbursement.
  • Submits adjusted UB04/837I and/or CMS1500/837P claims according to department and payer specific guidelines.
• Display Effective Communication Skills
  • Demonstrates active listening skills.
  • Notifies and keeps supervisor informed on denial and any other trends identified.
  • Follows telephone etiquette procedures set forth by the organization and/or individual department.
  • Professional/Courteous responses when communicating with customers, health system staff and management.
  • Can effectively communicate in meetings/forums to a large or medium group of individuals.
  • Works with supervisor to streamline process and decrease inefficiencies.
• Handling of Referrals
  • Timely and accurately handling of referrals, both regular and escalated priority from management, within department guidelines.
  • Documents clearly and appropriately all referrals (including patient inquiries) in the Source System when necessary.
  • If necessary, follows up with patients on final results of inquiry both timely and professionally.
  • Notifies patient of final results of account handling in question.
• Knowledge of System Applications
  • Demonstrates ability to learn and maintain a working knowledge on all the current health system applications.
  • Identify/obtain/print medical records as necessary for resolution of denial or system edits according to department guidelines.
  • Assists with testing and roll out plans to introduce new functionality within system applications used by the department.
• Auditing of Patient Accounts
  • Understand accounting and business principles to accurately determine the remaining balance on a given encounter.
  • Upon accurately auditing encounter or visit, is able to understand and update proration to make sure dollars are allocated to the appropriate benefit orders if needed.
  • Leverages all needed resources to complete an audit of an account.
  • Documents audit finding and actions taken in Source System when necessary.
• Claim/Appeal Follow Up with Third Party Payers
  • Full understanding of all necessary third party payer appeals, billing and follow up guidelines including specific time frames and possible form filing requirements.
  • Leverages payer websites, automated tools and contract resources to streamline the follow up process.
  • Appropriate documentation in Source System when necessary.
  • Ability to interpret all appeal and follow up correspondence for accurate handling.
• Denial Trending and Analysis
  • Can clearly identify, trend and articulate patterns and issues from provided denials data.
  • Can clearly provide alternative solutions with regards to denial findings.
  • Leverage all necessary denial data sources as needed for trending and analysis.
  • Leverage all necessary contract manager data sources and payer contracts as needed for reimbursement analysis.
  • Has the ability to effectively network and communicate with outside department, payers, patients and any other necessary resources to resolve denial issues timely.
• Transaction Review/Posting
  • Able to identify and correct transaction codes for proper write off classification.
  • Accurate usage of transaction codes for efficient organizational reporting.
  • Posts transactions within the departmental thresholds.
• Special Projects and Tasks as Assigned
  • Completion of any assigned projects timely, accurately and to the specifications of leadership.
  • Ability to articulate and communicate trend or other findings to various leadership personnel within the organization.
  • Ensure Daily/Weekly/Monthly assignments are handled accurately and timely.
• Maintaining Daily Workflow
  • Manages and maintains assigned workflow queues according to department guidelines.
  • Follow appropriate policies and procedures with regards to handling of denials and all other assigned queues.
  • Mail/Correspondence processed and handled following departmental guidelines.
  • Documents both timely and appropriately in Source System using proper documentation methods.
  • Fundamental understanding of different work item, state based and exception queues within the Patient Accounting System applications.

Qualifications

Education

• High school diploma, General Educational Development (GED) or equivalent required.
• Coursework in Coding, Billing or Healthcare Management normally acquired through enrollment in a secondary education institution or online classes through the American Health Information Management Association (AHIMA) preferred.
• Demonstration of knowledge and practice in medical terminology, third party payer appeals, denial trending and analysis, ICD-9, ICD-10, CPT4/HCPCS Coding, UB04 and CMS1500 claim data as supported by the Patient Billing Rep Skill Set Examination required.

Experience

• Minimum of 1-2 years experience in a healthcare business office setting operating patient accounting software, electronic billing software and/or accessing payer websites required.
• Prior experience interpreting contractual language preferred.

Skills

• Ability to create and submit both original and corrected claims.
• Skill in interpreting UB04 and/or CMS1500 claim data to be able to troubleshoot claim edits and resolve payer billing requirements both timely and accurately.
• Ability to audit accounts and payer explanation of benefits (EOBs) to determine appropriate action.
• Ability to maintain a working knowledge of multiple system applications.
• Ability to use effective communication skills in order 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 the 3rd party payers for claims and appeals submitted to ensure timely and accurate processing.
• Ability to review and clearly articulate denial trends and patterns to identify potential opportunity to prevent denials and maximize reimbursement.

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 – Not Related: Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF), 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 and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc), Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)

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