Patient Billing Representative

About the role

The Patient Billing Representative is responsible for accurate and timely billing of inpatient, outpatient, and ancillary services to various payers including commercial insurers, Medicare/Medicare Advantage, Medicaid/Medicaid HMOs, Workers’ Compensation/Liability carriers, and self-pay accounts. This role monitors accounts receivable, follows up on denials and underpayments, and ensures compliance with payer requirements, regulations, and organizational policies. The role also provides customer service to clients, families, and external parties regarding billing inquiries, payment arrangements, and account resolution.

Responsibilities

• Prepare and submit accurate claims to third-party payers and self-pay clients, ensuring compliance with payer rules and filing deadlines.
• Rebill claims when necessary; submit secondary and corrected claims electronically or on paper as required.
• Process refunds as necessary.
• Audit self-pay bills to confirm accuracy and compliance with Wisconsin Administrative Code.
• Monitor accounts receivable aging; research and resolve unpaid claims over established time thresholds.
• Review payments, denials, and explanation of benefits (EOBs) for accuracy and appropriateness.
• Initiate appeals, adjustments, transfers, write-offs, and refunds in accordance with policy.
• Collaborate with collection agencies, when applicable, to ensure proper handling of accounts.
• Investigate and resolve claim denials, underpayments, or incorrect reimbursements.
• Communicate with insurance companies, providers, and internal departments to resolve billing and authorization issues.
• Respond to client inquiries via phone or email, providing explanations of charges and account balances.
• Communicate with external customers and families to provide itemized statements or resolve billing questions.
• Work closely with Patient Access, Health Information Management, Utilization Review, Credentialing, and other departments to ensure accurate payer setup and claim resolution.
• Process bankruptcy and probate according to established guidelines.
• Perform other duties as assigned.

Requirements

• High school diploma or equivalent.
• Minimum of 1 year of experience in healthcare billing or revenue cycle functions.
• Authorized to work in the United States without the need for current or future employer sponsorship.

Preferred

• Associate degree in Health Information, Business, or a related field.
• Experience with behavioral health billing and multiple payer types.

Qualifications

• Required: High school diploma or equivalent.
• Minimum of 1 year of experience in healthcare billing or revenue cycle functions.
• Authorized to work in the United States without the need for current or future employer sponsorship.
• Potential for an Associate degree in Health Information, Business, or a related field.
• Experience with behavioral health billing and multiple payer types.

Skills

• Strong attention to detail.
• Excellent communication and problem-solving skills.
• Proficiency in healthcare billing software.
• Ability to work independently and as part of a team.

Benefits

As a full-time employee of NCHC, you are eligible for the Wisconsin Retirement System (WRS), which is a hybrid defined benefit plan. Participating staff contribute 7.2% and NCHC will match this at 100% each pay period. Additional benefits include PTO, paid holidays, health insurance, dental insurance, vision insurance, on-site bistro and cafeteria, employee assistance program, newly updated facility, and more.

Pay

The starting pay range for this role is $21.73 - $23.67 based on education and experience.

Schedule

This job is a full-time, in person position, usually working weekday business hours.