Patient Accounts Billing Representative

Job Title: Patient Accounts Billing Representative 

Supervised by: Business Office Director

Job Summary: Responsible for billing and follow up of accounts in the Patient Accounts Department for assigned financial classes, according to documented procedures. A/R activities include but are not limited to:

· Claim status

· Billing/Rebilling claims

· Credit Balance resolution

· Denial Management

· Aged Account follow up and resolution

· Maintaining accurate and up-to-date account information

· Cash posting

Demonstrates Competency in the Following Areas:

• Claim Status – Follow up with payer   prior to 35 days from last bill for accurate and complete status of the claim   per documented payer and claim follow up procedure. 
• Billing/Rebilling claims – Billing   and rebilling claims accurately and timely per the payer and   hospital-specific billing instructions. 
• Credit Balance resolution – Resolving   and preparing appropriate paperwork for credit balances per the department   credit balance procedures. 
• Denial Management – Resolving denied   claims within 5 days of denial posting/notification from payer. Notifying management of issues creating   unnecessary or excessive denials. Utilizing effective follow up and billing   techniques to reduce and prevent denials. 
• Aged Account follow up and resolution   – Working reports of accounts aged over 90 days monthly to resolve aged   account balances per payer and general follow up procedures. Notifying management of issues delaying   payment on claims in a timely manner.
• Maintaining accurate and up-to-date   account information on system – Following the system and reference procedures   to ensure proper account status at all times. Proper adjustment being posted, proper insurance (financial class)   assigned, proper account documentation and billing status.
• Cash posting – Posting patient   payments, insurance payments, and adjustments. 
• Stays informed about changes in   Medicare, Medicaid and assigned commercial payers. 
• Eligibility and coverage verification   – using appropriate systems and procedures to ensure proper coverage on   claims and correcting billing data. This includes various reports.

Other Essential Functions: 

• Works with other team members   effectively.
• Assist other team members with back   logs as needed.
• Identifying and assisting in   resolving issues affecting accounts receivable. 
• Answers the telephone in a polite   manner. Communicates information to   the appropriate staff. 
• Demonstrates the ability to be   flexible, organized and function well in stressful situations. 
• Maintaining a high level of   professionalism in all written or verbal communication. 
• Treats patients/families with   respect; ensures confidentiality of patient records. 
• Maintains a good working relationship   within the department and with other departments. 
• Maintains a professional working   relationship with insurance companies. 
• Performs other duties as assigned. 
• Ensures documentation meets current   standards and policies. 
• Supports and maintains a culture of   safety and quality.

Professional Requirements:

• Adheres to the dress code; appearance   is neat and clean. 
• Completes annual educational requirements. 
• Maintains regulatory requirements. 
• Reports to work on time and as scheduled; completes work within designated time. 
• Wears identification while on duty; uses computerized punch time system correctly. 
• Attends 12 staff meetings annually; or reads and returns all monthly staff minutes. 
• Participates in CQI activities.

 Regulatory Requirements:

· High school graduate or equivalent.

· Minimum 2 years of Medicare/Commercial billing experience, preferred.

Language Skills:

· Able to communicate effectively in English, both verbally and in writing.

· Additional languages preferred.

Skills:

· Thorough understanding of Medicare, Medicaid, HMOs, PPOs, private insurance companies.

· Basic computer knowledge, Microsoft Excel, data entry skills.

Physical Demands:

· Normal hospital environment. Close eye work. Hearing within normal range. Operates computer, typewriter, copier, calculator, telephone, fax machine, and general office equipment. Continuous sitting. Occasional standing, walking, and bending within the work areas. Minimal lifting up to 40 pounds.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care.