Billing and Follow-Up Representative-I Hospital BC/BS Payer) - PFS (Remote)

Job Title

Work Remote Position

Position Purpose

Performs day-to-day billing and follow-up activities within the revenue operations of an assigned Patient Business Services (PBS) location. Serves as a member of the billing and follow-up team at a PBS location responsible for billing and follow-up of government and non-government accounts. The position reports directly to the Supervisor Billing and Follow-up.

Essential Functions

Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.

Performs daily activities as part of the billing and follow-up team in support of the revenue cycle process for an assigned PBS location.

Documents claims billed, paid, settled, and follow-up in appropriate system(s).

Identifies and escalates issues affecting accurate billing and follow-up activities.

Adheres to proactive practices which include contacting the payer directly for payment due on accounts and reviewing and responding to all mail correspondence in a timely and accurate manner.

Communicates with appropriate hospital departments to clarify billing discrepancies and obtains demographic, clinical, financial, and insurance information.

Performs all routine follow-up functions which includes the investigation of overpayments, underpayments, credit balances and payment delays. Tasks will be routed to the correct workflows with the objective of maximizing reimbursement for services rendered and ensuring claims are paid or settled in a timely and accurate manner.

Researches claim rejections, make corrections, take corrective actions, and/or refer claims to appropriate colleagues to ensure timely and accurate claim resolution.

Proactively follow up on delayed payments by contacting patients and third-party payers determining the cause for delay and supplying additional data as required.

May prepare special reports as directed by the Supervisor Billing and Follow-Up to document follow-up services, e.g., number of claims and dollars billed, claims edited, claims unprocessed, etc.

Other duties as needed and assigned by the supervisor.

Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health's Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

Minimum Qualifications

High School diploma and successful completion of Trinity Health Trainee program as well as achievement of related program productivity and quality standards or at least one (1) year of experience and relevant knowledge of revenue cycle functions and systems working within a hospital or clinic environment, a health insurance company, managed care organization or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting or customer service activities or an equivalent combination of education and experience. Experience in a complex, multi-site environment preferred.

Basic understanding of Microsoft Office, including Outlook, Word, PowerPoint, and Excel.

Completion of regulatory/mandatory certifications and skills validation competencies preferred.

Excellent verbal and written communication and organizational abilities.

Strong interpersonal skills are necessary in dealing with internal and external customers.

Accuracy, attention to detail and time management skills.

Ability to work independently.

Ability perform billing and follow-up activities in a prompt and accurate manner in order to reduce potential financial loss to the patient and the Ministry Organization.

Must be comfortable operating in a collaborative, shared leadership environment.

Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

Physical and Mental Requirements and Working Conditions

This position operates in a typical office environment. The area is well lit, temperature controlled and free from hazards.

Incumbent communicates frequently, in person and over the phone, with people in all locations on product support issues.

Manual dexterity is needed in order to operate a keyboard. Hearing is needed for extensive telephone and in person communication.

The incumbent is subject to eyestrain due to the many hours spent looking at a CRT screen. The noise level is low to moderate.

Must be able to set and organize own work priorities and adapt to them as they change frequently.

Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.

Must possess the ability to comply with Trinity Health policies and procedures.

The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.