Patient Representative Biller

Job Title

Qualifications

Education

High school graduate or equivalent

Experience/Skills

Athena experience preferred

Possesses knowledge of business office operations

Understands third party billing requirements

Understands Medicare/Medicaid inpatient and outpatient billing

Strives for customer satisfaction when responding to all patient/customer inquires (internal customers)

Experience using office equipment

Adapts professionally to changes in procedures and/or workload

Possesses excellent written and oral communication skills

Works independently with little supervision

Maintains concentration

Remains committed to a "cross training" philosophy for all assigned tasks

Working Conditions

Works in a well-ventilated, well-lit general office environment

Works well under pressure with attention to time constraints

Routine Responsibilities

Behavioral Expectations

Consistently complies with established Behavioral Expectations

Essential Duties

Reviews, identifies, and corrects claims issues identified in inhouse hold and the claim scrubbing holds

Sends clean, timely claims out on first billing

Works reconciliation desktops to ensure upfront rejection of claims are processed and resubmitted to correct payer

Reviews assigned outstanding accounts receivable by using ATB, queues, and payment reports

Submits timely and accurate adjustments documenting activity in account

Understands and manages denials, submitting timely disputes and appeals

Follows up with insurance companies to ensure claims are processed and paid correctly according to contract

Understands payor contracts and billing guidelines. revenue codes, cpt codes, modifiers, and payor-specific guidelines

Investigates and reports claims denial trends with payer documentation for departments to review and establish action plan

Provides back-up phone support to billing lines daily

Full time/Day shift 80 hours/Biweekly

Sullivan County Community Hospital