Patient Billing Rep I

Job Summary Location: Methodist Corporate Office Address: 825 S 169th St., Omaha, NE Work Schedule: Mon - Fri, 7:00am to 3:30pm Responsible for billing, electronic claims submission, follow up, and collections of patient accounts. Responsibilities Electronic and Hardcopy Billing All EDI and paper claims submitted are to be billed as needed following department and payer specific guidelines. Obtain appropriate EOBs through use of health system resources. Review Billing Scrubber Claim Detail Screens to ensure data is appropriate for claim submission. Ensure that claim corrections identified in billing scrubber are appropriately updated and documented in Source System. Prepare secondary and tertiary billings, manually and electronically on UB04s and/or 1500s for accurate reimbursement. Submit adjusted UB04/837I and/or CMS1500/837P claims according to department and payer specific guidelines. Display Effective Communication Skills Demonstrate active listening skills. Notify and keep leads and supervisors informed on issues identified. Follow telephone etiquette procedures set forth by the organization and/or individual department. Give professional and courteous responses when communicating with customers, health system staff and management. Handling of Referrals Timely and accurately handle referrals, both regular and escalated priority from management, within department guidelines. Document clearly and appropriately all referrals (including patient inquiries) in the Source System when necessary. Follow up with patients on final results of inquiry in a timely and professional manner; notify patient of final results of account handling in question. Knowledge of System Applications Demonstrate ability to learn and maintain a working knowledge of all current health system applications. Identify, obtain, and print medical records as necessary for resolution of denial or system edits according to department guidelines. Auditing of Patient Accounts Understand accounting and business principles to accurately determine the remaining balance on a given encounter. Upon accurately auditing encounter or visit, understand and update proration to ensure dollars are allocated to the appropriate benefit orders if needed. Leverage all needed resources to complete an audit of an account. Document audit findings and actions taken in Source System when necessary. Claim Follow Up with Third Party Payers Have full understanding of all necessary third party billing and follow up processes based on department specifications. Have full understanding of all necessary contract related requirements. Leverage payer websites and necessary tools to streamline the follow up process. Provide appropriate documentation in Source System when necessary. Interpret correspondence assigned for accurate handling. Special Projects and Tasks as Assigned Complete any assigned projects timely, accurately and to the specifications of leadership. Ensure daily, weekly, and monthly assignments are handled accurately and timely. Maintaining Daily Workflow Manage and maintain assigned workflow queues according to department guidelines. Process mail and correspondence following departmental guidelines. Document both timely and appropriately in Source System using proper documentation methods. Have fundamental understanding of different work item, state based and exception queues within the Patient Accounting System applications. Physical Requirements Weight Demands Light Work - Exerting up to 20 pounds of force. Physical Activity Occasionally Performed (1%-33%) Balancing Climbing Carrying Crawling Crouching Distinguish colors Kneeling Lifting Pulling/Pushing ReachingStanding Stooping/bending Twisting Walking Frequently Performed (34%-66%) Hearing Repetitive Motions Seeing/Visual Speaking/talking Constantly Performed (67%-100%) Fingering/Touching Grasping Keyboarding/typing Sitting Job Hazards Not Related: Biological agents (primary airborne and bloodborn viruses) (Jobs with patient contact) Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment) Equipment/Machinery/Tools Explosives (pressurized gas) Electrical Shock/Static Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc) Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that cause injuries to tissue or thermal or photochemical means) Rare (1-33%): Chemical agents (Toxic, Corrosive, Flammable, Latex) Mechanical moving parts/vibrations Job Requirements Education High school diploma, General Educational Development (GED) or equivalent required Coursework in Coding, Billing or Healthcare Management normally acquired through enrollment in a secondary education institution or online classes through the American Health Information Management Association (AHIMA) preferred Experience Minimum of one (1) year prior experience in healthcare third party billing and/or claims processing preferred Prior exposure to UP04 and/or CMS1500 claim data normally acquired through work in a physician’s office or other healthcare setting preferred License/Certifications N/A Skills/Knowledge/Abilities Skill in interpreting UB04 and/or CMS1500 claim data to be able to troubleshoot claim edits and resolve payer billing requirements both timely and accurately Ability to create and submit both original and corrected claims Ability to audit accounts and payer explanation of benefits (EOBs) to determine appropriate action Ability to use effective communication skills to handle patient inquiries, attorneys, health system staff and payers on a professional level Knowledge and understanding of accounting and business principles to enable accurate auditing of patient accounts Ability to follow up with the third party payers for claims and appeals submitted to ensure timely and accurate processing Ability to maintain a working knowledge of multiple system applications Nebraska Methodist Health System is an affirmative action/equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation, gender identity, or any other classification protected by Federal, state or local law. #J-18808-Ljbffr Nebraska Methodist Health System