Patient Billing Rep I

Fremont Area Medical Center

  • Omaha, NE
  • Permanent
  • Full-time
  • 2 months ago
Purpose of Job

Responsible for billing, electronic claims submission, follow up and collections of patient accounts.

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 Heath 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 in order to handle patient inquires, 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 3rd party payers for claims and appeals submitted to ensure timely and accurate processing.

Ability to maintain a working knowledge of multiple 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

Reaching

Standing

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 air born and blood born viruses) (Jobs with Patient contact) (BBF)

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 causes injuries to tissue or thermal or photochemical means)

Rare (1-33%):

Chemical agents (Toxic, Corrosive, Flammable, Latex)

Mechanical moving parts/vibrations

Note: Safety Officer can assist with identification of job hazards

Essential Job Functions

Essential Functions I

Electronic and Hardcopy Billing

All EDI and paper claims submitted are to be billed as needed following department and payer specific guidelines.

Obtains appropriate EOB's through use of health system resources.

Reviews 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.

Prepares secondary and tertiary billings, manually and electronically on UB04's and/or 1500's for accurate reimbursement.

Submits adjusted UB04/837I and/or CMS1500/837P claims according to department and payer specific guidelines. Display Effective Communication Skills

Demonstrates active listening skills.

Notifies and keeps leads and supervisors informed on issues identified.

Follows telephone etiquette procedures set forth by the organization and/or individual department.

Professional/Courteous responses when communicating with customers, health system staff and management. Handling of Referrals

Timely and accurately handling of referrals, both regular and escalated priority from management, within department guidelines.

Documents clearly and appropriately all referrals (including patient inquiries) in the Source System when necessary.

If necessary, follows up with patients on final results of inquiry both timely and professionally. Notifies patient of final results of account handling in question. Knowledge of System Applications

Demonstrates ability to learn and maintain a working knowledge on all the current health system applications.

Identify/obtain/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, is able to understand and update proration to make sure dollars are allocated to the appropriate benefit orders if needed.

Leverages all needed resources to complete an audit of an account.

Documents audit finding and actions taken in Source System when necessary. Claim Follow Up with Third Party Payers

Full understanding of all necessary third party billing and follow up processes based on department specifications.

Full understanding of all necessary contract related requirements.

Leverages payer websites and necessary tools to streamline the follow up process.

Appropriate documentation in Source System when necessary.

Ability to interpret correspondence assigned for accurate handling. Special Projects and Tasks as Assigned

Completion of any assigned projects timely, accurately and to the specifications of leadership.

Ensure Daily/Weekly/Monthly assignments are handled accurately and timely. Maintaining Daily Workflow

Manages and maintains assigned workflow queues according to department guidelines.

Mail/Correspondence processed and handled following departmental guidelines.

Documents both timely and appropriately in Source System using proper documentation methods.

Fundamental understanding of different work item, state based and exception queues within the Patient Accounting System applications.

Essential Functions II

Participates in mandatory in-services and/or CE programs as mandated by policies and procedures/external agencies and as directed by management. Follows and understands the mission, vision, core values, Employee Standards of Behavior and company policies/procedures. Other duties as assigned.

Fremont Area Medical Center