Professional Billing Representative| Professional Billing, Full-Time

Billing Functions

Ensures insurance claims are sent timely and accurately to government, commercial and managed care plans, adhering to payer timely filing requirements.
Researched and resolves claim edits via Epic Work Queues (WQ) and/or external billing software, including electronic and paper processing.
Prepares and processes secondary and tertiary insurance claims completing coordination of benefit tables accurately reflecting prior payer reimbursement.
Ensures compliance and billing requirements for Worker’s Compensation (WC) and third-party liability claims are met.
Ensures claims submission with all appropriate documentation, using the Release of Information (ROI) module in Health Information System (HIS).
Verifies and updates patient account demographic and financial information, processing Real-Time Eligibility (RTE); contacts account guarantor and/or payer as appropriate for demographic and financial clarification.
Enters complete and appropriate account note(s) in HIS identifying actions taken to reconcile claims.
Works various hospital departments to ensure all authorizations, coding and charge information is in place to expedite clams processing and accurate account reimbursement.
Understands Medicare Common Working File (CWF) and how to determine primary payer based on Medicare Secondary Payer Questionnaire (MSPQ).
Works in conjunction with various physician offices; providers and managers, to obtain billing and coding information.

Accounts Receivable Management

Manages account review and processing from system WQs, insures timely follow-up on all unpaid claims within appropriate billing cycle;
manages system denial remark module, taking steps to rectify current denial.
Contacts payers via payer websites and telephone for claim status and/or clarification on denied claims.
Manages outstanding accounts receivable per departmental standards; maintains each payer’s outstanding receivables at or above departmental established goals.
Prepares and submits appeals, collecting all pertinent documentation; filing per each individual payer’s guidelines.

Customer Service

Supports all team members and co-workers, engaging in positive interactions at all times.
Exhibits professional communication with customers, family members, co-workers, vendors and payers, by providing helpful assistance and responding timely to requests.
Instructs active listening prior to responding, remains calm and confident when assisting others.
Demonstrates a strong representation of Memorial Health’s values through attitude, actions and communications with others.
Addresses patient concerns and complaints and provides resolution for readily resolved issues; escalates more in-depth issues as appropriate to assist with service recovery.
Displays enthusiasm while applying quick thinking and resourcefulness in providing assistance.

Critical Thinking

Actively looks for and creates opportunities to improve department, staff and personal development.
Develops and demonstrates knowledge of current developments in field to maintain competency.
Utilizes hospital and departmental policies and procedures.

Interpersonal

Acts as a resource for new employees and precepts as needed.
All interactions are conducted in a professional manner.
Demonstrates a positive attitude.
Provides excellent customer service, facilitates quality care delivery and fosters an atmosphere of understanding cultural diversity.
Communicates dissatisfaction with issues to direct supervisor; actively contributes to the solution of problems and refrain from promoting dissatisfaction among co-workers.
Must be a team player; cooperate with co-workers to resolve conflict through one on one negotiation or with the assistance of the Director or their designee.
Maintains confidentiality at all times to protect patient’s privacy and maintains HIPAA privacy and security regulations.

Documentation

Documents accurately (painting a complete picture providing directions to other health care providers); refrains from using unapproved abbreviations in written or computer documentation.
Documentation is completed on a daily basis.
Understands the importance of accurate completion of documentation and Hospital accreditation requirements and how it impacts hospital payment and certification programs.

Education

HIPAA privacy regulations and related procedures
CMS updates on patient rights

Other

Exhibits behaviors reflective of Memorial’s core values: Compassion, Accountability, Respect, Excellence, and Service
Demonstrates regular and predictable attendance.
Attends all mandatory education and in-services (i.e., team training, safety, infection control, etc.); completes mandatory health requirements.
Employee performs within the prescribed limits of the hospital’s and department’s Ethics and Compliance program and is responsible to detect, observe and report compliance variances to their immediate supervisor, or upward through the chain of command, the Compliance Officer, or the hospital hotline.
Performs other duties as required or assigned.
Attends all mandatory education and in-services (i.e., team training, safety, infection control, etc.).

Requirements

High school diploma or equivalent
Three (3) years’ experience in the medical field preferably in a hospital setting.
Knowledge of revenue cycle functions, understanding of health insurance and government programs, billing processes, managed care contracts, coordination of benefits with ability to interpret explanation of benefits desired.
Knowledge of office practices and procedures, medical terminology and the ability to communicate effectively.
Must be proficient with Microsoft Word, Excel and PowerPoint.

Benefits

• Medical Insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• Flexible Spending Account
• Time Off: Vacation, Sick Leave, 11 Paid Holidays, Personal Day
• Retirement: Ohio Public Employee Retirement System, Deferred Compensation
• Other: Tuition Reimbursement, Kidzlink Daycare Center, Employee Recognition, Free Parking, Wellness Center, Competitive Salaries, Community/Family Atmosphere

Location

Approx. 25 minutes away from Dublin, OH
Approx. 30 minutes away from Hillard, OH
Approx. 30 minutes away from Delaware, OH
Approx. 30 minutes away from Powell, OH