Patient Account Representative

Sheridan Memorial Hospital Billing Specialist

At Sheridan Memorial Hospital, we are proud to be ranked in the top 13.6% of hospitals rated by the Centers for Medicare and Medicaid Services. We believe that our ability to deliver excellent healthcare begins with our people, and we are proud of our more than 850 skilled, experienced, and caring employees. We have over 100 providers who specialize in 25 areas of expertise. Our facility is state-of-the-art, and we are dedicated to providing outstanding patient-centered care. Nestled at the foothills of the Big Horn Mountains in northern Wyoming, spectacular scenery and outdoor activities abound. Our hospital has the latest technology and equipment comparative to that of many larger facilities, and you will find our staff is friendly, compassionate, caring, and courteous. We focus on creating and nurturing a workplace that encourages, recognizes, and rewards individual effort and creativity. Leadership is responsive to changing modes of healthcare delivery and adapts accordingly. We value effective communication and honesty and believe teamwork based on mutual respect is key to success.

Job Summary

Responsible for compiling itemized hospital bills, verifying patient insurance coverage and computing patient insurance benefits. Works closely with the Admitting Office, Medical Records and insurance companies. Participates in Performance Improvement activities.

Essential Duties/Responsibilities

• Verifies accurate encounter information by working Edit Failure Working in Cerner, making necessary corrections to insure timely claim submission.
• Monitors all claims in Emdeon correcting edits as need to insure claim submission and reimbursement.
• Contacts patients when additional information is required to file an insurance claim or when the insurance company has requested additional information from the member.
• Stays informed about changes in Medicare and Medicaid, Blue Cross/Blue Shield and other third party payors.
• Processes correspondence and Explanation of Benefits in a timely manner.
• Processes overpayment refunds as required.
• Timely in making contact with insurance companies on claims that have exceeded the time expectation for payment.
• Remains current on Workers Compensation and other third party payors for billing functions.
• Stays current on assigned patient encounter #workQ in Cerner RevenueCycle.
• Demonstrates the ability to be flexible, organized and function well in stressful situations.
• Interacts with patients/families in a professional manner.
• Provides explanations regarding statements, insurance coverage.
• 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 standards and policies.

Minimum Requirements

• Education/Experience/Licenses and Certifications
• High school diploma or general equivalency diploma (GED), required.
• Medical terminology, preferred.
• Billing or accounting, preferred.
• Additional Skills
• Ability to effectively communicate in English, both reading and writing.
• Multi-line telephone knowledge.
• Computer knowledge.
• Ability to operate designated equipment as specified, including computer keyboarding.
• Basic clerical training, including basic filing procedures (both numerically and alphabetically).
• Ability to work under pressure with time constraints.
• Basic knowledge of medical record content and sequence.
• Ability to function independently with minimal direction.

Specific demands not listed: Possible exposure to blood and or body fluids / infectious disease / hazardous waste requiring the use of Personal Protective Equipment. Exposure to odorous chemicals / specimens and Latex products. Pre-employment drug and alcohol screening is required. Sheridan Memorial Hospital is an equal opportunity/Affirmative Action employer and gives consideration for employment to qualified applicants without regard to race, color, religion, age, sex, national origin, disability or protected veteran status.