Patient Financial Services Representative - Hospital Billing

Job Description

Essential Duties & Responsibilities including but not limited to:

• Utilizes the Epic Hospital Billing System to review and monitor accounts through the Billing, Denial, & Follow-Up work queues
• Work assigned outstanding and denied accounts within Hospital Billing, Follow Up, & Denial work queues while maintaining established productivity requirements.
• Contact insurance carriers or other responsible parties to confirm payment dates, question why a claim was denied or questions why a claim was not processed for payment or denial.
• Perform all Hospital Billing, Follow Up, and Denial activities necessary to obtain payment/resolution of claims.
• Review entire account to ensure claims were billed properly, payments were applied correctly, and all necessary adjustments were made prior to moving to next responsible party and/or adjusting balances and removing from work queue(s).
• Gather all necessary documentation needed to have claims reprocessed/adjudicated for maximum reimbursement
• Informs and/or transfers to management of any problem accounts that require escalation within 2 days of identification
• Document all actions taken within the EPIC account notes section and/or follow up/denial activities note sections.
• Adhere to all departmental Hospital Billing, Follow up, and Denial policies and procedures/training documents.
• Complete necessary training sessions required for the Hospital Billing system and demonstrate good working knowledge from those sessions to successfully resolve assigned accounts within Follow Up and Denial work queues
• Document all inactive periods and make them available upon management's request.
• Identifies problems in Claims Edit work queue and resubmits claims through the Epic billing system.
• Works claims edit work queue daily and resubmit claims through the Epic billing system
• Works External claim edits from Clearinghouse and resubmits claims through the Epic billing system
• Handles Paper claims processing including proper documentation
• Communicate all claims/data problems that cannot be handled to the Supervisor/Manager within one (1) day of identifying the problem.
• Identifies and researches all incomplete or inaccurate information on claims, demonstrates proper handling and escalation as needed.
• Handles payer 277 rejections of accounts and resubmits claims through Epic Billing system or other means of submission (i.e., email, fax, payer portal, certified mail) and provides trends to management for payer outreach and/or internal billing system updates to ensure timely filing and reimbursement

Minimum Qualifications

• Education: High School Diploma / GED Required
• Licensure, Certification & Registration: None Required
• Experience: At least two (2) years AR/Billing experience required
• Skills, Knowledge & Abilities: Clear oral and written communication, Professional telephone & email etiquette, Able to interact with insurance carriers, patients, and co-workers in a professional and helpful manner, Use of billing computer and PC skills, Problem solving and decision making skills, Able to work independently

Preferred Qualifications & Skills

• Experience in Revenue Cycle Billing & Accounts Receivable
• Experience working with EPIC

Key Relationships

• Senior Administration To support senior management to meet the overall goals of the Revenue Cycle Departments.
• Managers To guide, educate/train, plan, communicate, problem solve, and manage daily activities.
• Revenue Cycle Teams To represent work units as necessary with reporting, feedback, and other duties as necessary.

Physical Requirements & Environment

• Office environment-This job requires bending, carrying, pulling, pushing, reaching, standing, stooping, walking, and lifting over 10 lbs. There will be occasional need for climbing stairs, lifting more than 50 – 100 lbs. and sitting. Constant use of hearing, sight, and speech. Frequent use of smell and touch. Frequent keyboard and telephone use. Constant concentration and problem solving.

Pay Range

$21.00 – $28.26