Billing Representative I

The Hospital Billing Representative I is responsible for various tasks in the Accounts Receivables reconciliation process including but not limited to: examining, correcting and consistently updating Patient Health Information to ensure accurate insurance billing/payment/follow-up; submit bills electronically to payers using designated claims software for the corporation; reviewing rejected claims in such billing software to scrub claims and send them clean to the payer to avoid denials; applying appropriate contractual and self-pay adjustments; resolving patient and insurance carrier inquiries; communicate with physician offices, as necessary, to obtain authorizations or notify them of medically unnecessary orders for diagnostics; using on-line systems provided by multiple payers to verify eligibility and benefits and checking claim status; maintain appropriate/ consistent documentation on accounts worked; apply proper account management principals to accounts to ensure accurate billing; identify non-payment trends by payer and notify management; work based on goals set by management for productivity of validated claims being submitted on a daily basis; makes account corrections as necessary to ensure prompt payment of claims, regardless of which department is responsible for obtaining this information; prints and mails medical records and itemized statements as necessary for payers requiring paper claims submissions; if necessary, phones patients or employers to verify health insurance or worker's compensation information in order to submit claims timely and accurately; maintains a high level of professionalism and communication when it comes to working with other areas of the business office or revenue cycle in an effort to submit bills timely and accurately

• Maintains responsibility for the billing process for patient accounts including but not limited to: examining, correcting and consistently updating patient health insurance claims to ensure prompt insurance payment/follow-up.
• Resolves patient and insurance carrier inquiries related to billing for the revenue cycle.
• Uses on-line systems provided by multiple payers to verify eligibility and benefits and checking claim status appropriately.
• Makes telephone calls to the payer to inquire about denial trends in billing to ensure claims are sent “clean”.
• Maintains appropriate/consistent documentation on accounts worked within the patient accounting systems.
• Reviews memos on accounts within patient accounting systems for all reprinted or rebilled claims to ensure any necessary updates/changes are made before submission to the payer.
• Identifies non-payment trends by payer and notifies systems coordinators and management in order to change billing tables to bill accurately or to adjust off timely, to reduce number of A/R days.

Minimum Education

• High School Diploma or Equivalent Required

Minimum Work Experience

• 6 months relevant revenue cycle experience (patient access, financial assistance, insurance billing, patient and/or insurance collections, reimbursement, customer service, payer contracting, or coding) Required