The representative is responsible for collections, account follow up, billing allowance posting for the accounts assigned to them
Duties and Responsibilities
- Ability to use various workflow system and client host system such as STAR, SMS, EAGLE and EPIC, as well as other tools available to them to collect payments and resolve accounts
- Working knowledge of the insurance follow-up process with understanding of the fundamental concepts in healthcare reimbursement methodologies
- Understanding of government, Medicare and Medicaid claims
- Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites
- Review and updates all patient and financial information accurately as given.
- Verifies that information is accurate as to individual or insurance company responsible for payment of bill.
- Monitors all billings for accuracy, updating any that contain known errors.
- Monitors Medicaid/healthy options coupons to assure services are billed within expected time frames
- Bills all hospital services to primary insurer or patient correctly and within expected time frame
- Follows up with insurance companies on all assigned accounts within expected time frame
- Explains hospital regulations with regard to methods for payment of accounts and maintains complete working knowledge of insurance regulations and hospital insurance contracts
- Identify and report underpayments and denial trends
- Ability to analyze, identify and resolve issues causing payer payment delays Initiate appeals when necessary
- Basic knowledge of healthcare claims processing including: ICD-9/10, CPT and HCPC codes, as well as UB-04
- Ability to manipulate excel spreadsheets and communicate results
- Meets and maintains daily productivity and quality standards established in departmental policies
- Act professionally, cooperatively and courteously with patients, insurance payors, co-workers, management and clients
- Perform special projects and other duties as needed by the management team.
- Maintain confidentiality at all times
- Use, protect and disclose patients protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties
- Experience in Hospital/Facility billing required
- 2-3 years' experience in insurance collections, including submitting and following up on claims
- Ability to work well individually and in a team environment.
- Proficiency with Microsoft Office including Excel and Word
- Strong organizations, communication and written skills
- Basic math and typing skills
- High School Diploma
- Medical Billing and Coding certification preferred, but not required