PATIENT ACCOUNT REP-MPG

Billing Specialist

Responsible for effectively billing or rebilling all accounts to the appropriate insurance carrier by implementing billing procedures in a timely manner. Responsible and accountable for pursuing collection of all receivables from insurance, guarantor, and/or any other responsible party.

Responsibilities

PRINCIPAL DUTIES AND RESPONSIBILITIES (*Essential Functions)

• Follows-up on outstanding accounts through contact, and inquiry to third party payors to facilitate prompt resolution, or payment. Actively pursues payment from patient, or guarantor on all outstanding account balances, after third party payment, or rejection based upon collection guidelines, on a daily basis.

• Identifies and investigates delinquent accounts for special circumstances affecting payment delays, and recommends the appropriate disposition. Reviews bad debt prelist report, on a weekly basis, to ensure that adequate follow-up, or collection efforts have been performed prior to transferring to the bad debt.

• Contacts patients to obtain insurance and COB information, and inform them of financial responsibility. Discusses payment options.

• Prepares appropriate billing documents based upon current payor, and hospital guidelines, for all third party payors.

• Prepares and processes any necessary adjustments, or coding changes on accounts, through the system based upon follow-up, to expedite the collection process, and to ensure the accuracy of the account daily.

• Reviews audit discrepancy report, pulls the account, processes the debit or credit adjustments, rebills the account to the third party payor, and moves monies back to the insurance load.

• Performs other duties as needed and/or assigned.

Qualifications

JOB SPECIFICATIONS (Minimum Requirements)

KNOWLEDGE, SKILLS, AND ABILITIES

• Must have working knowledge of insurance claim filing, collections, and established refund processing procedures.
• Working knowledge of personal computer skills, with proficient use of keyboard and calculator.
• Ability to prioritize job functions, work independently, and exercise good judgment.
• Must possess good written and verbal communication skills, good organizational and analytical skills, and strong mathematical aptitude.
• Productivity Standards of 75 accounts a day, minimum.
• Quality Standards of 95% A/R aging 90 days less than 30% of total A/R.
• Accounts on WQ's can not be aged more than 30 days.
• Mail and correspondence must be worked within 5 working days.
• Medical Records request follow-up must be worked within 7 working days from first request.
• Account rejections in Quadax must be turned around within 2 days of receipt.
• Follow up with UM or physicians office on Prior Authorization denial within 1 day of receipt.
• Bad debt accounts to be worked weekly and completed by month end.
• Resolve and complete patient complaints daily.
• Denial Write-Off rate needs to be <0.5% of net revenue.

EDUCATION

All post high school education must have been obtained from a recognized College or University. Additional education or experience may be substituted requirements on a year for year basis should the substitution not conflict with State or Board certification/license requirements.

• High School Diploma/GED Equivalent Required
• Associate's Degree in Business Administration Preferred

EXPERIENCE

• Six (6) years of responsible work experience in a Business Office.
• Knowledge of UB-04 and 1500 billing Preferred.

STANDARDS OF BEHAVIOR

Meets the Standards of Behavior as outlined in Personnel Policy and Procedure #1, Employee Relations Code.

CONFIDENTIALITY/HIPAA/CORPORATE COMPLIANCE

Demonstrates knowledge of procedures for protecting and maintaining security, confidentiality and integrity of employee, patient, family, organizational and other medical information. Understands and supports the commitment of Methodist Hospitals in adhering to federal, state and local laws, rules and regulations governing ethical business practices for healthcare providers.

DISCLAIMER - The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. The statements are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required.