Professional Billing Representative| Professional Billing, Full-Time

Professional Billing RepresentativeWe are looking for a Professional Billing Representative to join our collaborative team at Memorial Health!What You'll Do:Billing Functions:Ensures insurance claims are sent timely and accurately to government, commercial and managed care plans, adhering to payer timely filing requirementsResearches and resolves claim edits via Epic Work Queues (WQ) and/or external billing software, including electronic and paper processingPrepares and processes secondary and tertiary insurance claims completing coordination of benefit tables accurately reflecting prior payer reimbursementEnsures compliance and billing requirements for Worker's Compensation (WC) and third-party liability claims are metEnsures 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); contacting account guarantor and/or payer as appropriate for demographic and financial clarificationEnters complete and appropriate account note(s) in HIS identifying actions taken to reconcile claimsWorks various hospital departments to ensure all authorizations, coding and charge information is in place to expedite clams processing and accurate account reimbursementUnderstands 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 informationAccounts 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 denialContacts payers via payer websites and telephone for claim status and/or clarification on denied claimsManages outstanding accounts receivable per departmental standards; maintains each payer's outstanding receivables at or above departmental established goalsPrepares and submits appeals, collecting all pertinent documentation; filing per each individual payer's guidelinesCustomer Service:Supports all team members and co-workers, engaging in positive interactions at all timesExhibits professional communication with customers, family members, co-workers, vendors and payers, by providing helpful assistance and responding timely to requests.Insures active listening prior to responding, remains calm and confident when assisting othersDemonstrates a strong representation of Memorial Health's values through attitude, actions and communications with othersAddresses patient concerns and complaints and provides resolution for readily resolved issues; escalates more in-depth issues as appropriate to assist with service recoveryDisplays enthusiasm while applying quick thinking and resourcefulness in providing assistanceCritical Thinking:Actively looks for and creates opportunities to improve department, staff and personal developmentDevelops and demonstrates knowledge of current developments in field to maintain competencyUtilizes hospital and departmental policies and proceduresInterpersonal:Acts as a resource for new employees and precepts as neededAll interactions are conducted in a professional mannerDemonstrates a positive attitudeProvides excellent customer service, facilitates quality care delivery and fosters an atmosphere of understanding cultural diversityCommunicates dissatisfaction with issues to direct supervisor; actively contributes to the solution of problems and refrain from promoting dissatisfaction among co-workersMust 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 designeeMaintains confidentiality at all times to protect patient's privacy and maintains HIPAA privacy and security regulationsDocumentation:Documents accurately (painting a complete picture providing directions to other health care providers); refrains from using unapproved abbreviations in written or computer documentationDocumentation is completed on a daily basisUnderstands the importance of accurate completion of documentation and Hospital accreditation requirements and how it impacts hospital payment and certification programsEducation:HIPAA privacy regulations and related proceduresCMS updates on patient rightsOther:Exhibits behaviors reflective of Memorial's core values: Compassion, Accountability, Respect, Excellence, and ServiceDemonstrates 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 equivalentThree (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.Shift: 1stHours: 80 per pay (Every two weeks)Benefits:Medical InsuranceDental InsuranceVision InsuranceLife InsuranceFlexible Spending AccountTime Off:VacationSick Leave11 Paid HolidaysPersonal DayRetirement:Ohio Public Employee Retirement SystemDeferred CompensationOther:Tuition ReimbursementKidzlink Daycare CenterEmployee RecognitionFree ParkingWellness CenterCompetitive SalariesCommunity/Family AtmosphereLocation:Approx. 25 minutes away from Dublin, OHApprox. 30 minutes away from Hilliard, OHApprox. 30 minutes away from Delaware, OHApprox. 30 minutes away from Powell, OHWe look forward to seeing your application! Memorial Health University Medical Center