Patient Representative/Biller, Duncan Regional Hospital

Responsibilities

• Accurately posts payments and creates payment plans for upcoming services and/or outstanding balances.
• Reviews balances and communicates to patient and other affected parties about outstanding balances.
• Assists patients in resolving account questions and concerns.
• Coordinates and completes financial assistance application for charity care program.
• Understands the revenue cycle, including all involved parties and appropriate escalation pathways.
• Contact payers, via website, phone and/or correspondence, regarding reimbursement of unpaid accounts over thirty (30) days or more, also researching and following up on denials and requests for additional information.
• Interpret Managed Care/Commercial contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection.
• Make necessary adjustments as required by plan reimbursement.
• Performs payment validation by utilizing internal and/or external resources to ensure proper reimbursement.
• Reviews, researches, and appeals partially denied claims for reconsideration.
• Responsible for contacting patients to gain additional information required to resolve an outstanding insurance balance.
• Responsible for posting payments both electronically and manually.
• Analyzes, investigates, and resolves claims errors in the clearinghouse system to ensure claims are filed to carriers timely.
• Maintains professional and technical knowledge through continuing education opportunities including internal and external educational offerings.

Qualifications

• Communication skills including fluency in oral and written English.
• Basic computer skills including the ability to send/receive email, navigate information technology associated with the position, and use Electronic Health Record information tools.
• Ability to remain flexible to quickly adapt to urgent situations.
• Ability to adapt procedures, processes, tools, equipment, and techniques to accomplish the requirements of the position.
• High school diploma or equivalent.
• At least 1 year of experience in medical claims recovery and/or collections and basic know of billing and collections rules and regulations preferred.
• Strong Home Care and Hospice medical billing/collections, coding, and denial management experience preferred.
• Ability to read, interpret and apply policies, procedures, and requirements.
• Familiarity with standard office equipment.
• Ability to handle multiple tasks in timely manner.