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Patient Billing Rep II

Methodist Health System locationOmaha, NE
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413 positions
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413 positions
info linkReport a probelm Originally Posted : December 01, 2021 | Expires : January 30, 2022

Details

Salary
Unspecified
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Job Location
Omaha, NE, United States

Description

  • 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.
      • Demonstration of knowledge and practice in medical terminology, third party payer appeals, denial trending and analysis, ICD-9, ICD-10, CPT4/HCPCS Coding, UB04 and CMS1500 claim data as supported by the Patient Billing Rep Skill Set Examination required.

    • Experience
      • Minimum of 1-2 years experience in a healthcare business office setting operating patient accounting software, electronic billing software and/or accessing payer websites required.
      • Prior experience interpreting contractual language preferred.

    • License/Certifications
      • N/A

    • Skills/Knowledge/Abilities
      • Ability to create and submit both original and corrected claims.
      • 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 audit accounts and payer explanation of benefits (EOBs) to determine appropriate action.
      • Ability to maintain a working knowledge of multiple system applications.
      • 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 review and clearly articulate denial trends and patterns to identify potential opportunity to prevent denials and maximize reimbursement.
  • 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

      • UB04/837I and CMS1500/837P Claim Edit Handling/Billing/Interpretation
        • 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 supervisor informed on denial and any other trends 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.
        • Can effectively communicate in meetings/forums to a large or medium group of individuals.
        • Works with supervisor to streamline process and decrease inefficiencies.

      • 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.
        • Assists with testing and roll out plans to introduce new functionality within system applications used by the department.

      • 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/Appeal Follow Up with Third Party Payers
        • Full understanding of all necessary third party payer appeals, billing and follow up guidelines including specific time frames and possible form filing requirements.
        • Leverages payer websites, automated tools and contract resources to streamline the follow up process.
        • Appropriate documentation in Source System when necessary.
        • Ability to interpret all appeal and follow up correspondence for accurate handling.

      • Denial Trending and Analysis
        • Can clearly identify, trend and articulate patterns and issues from provided denials data.
        • Can clearly provide alternative solutions with regards to denial findings.
        • Leverage all necessary denial data sources as needed for trending and analysis.
        • Leverage all necessary contract manager data sources and payer contracts as needed for reimbursement analysis.
        • Has the ability to effectively network and communicate with outside department, payers, patients and any other necessary resources to resolve denial issues timely.

      • Transaction Review/Posting
        • Able to identify and correct transaction codes for proper write off classification.
        • Accurate usage of transaction codes for efficient organizational reporting.
        • Posts transactions within the departmental thresholds.

      • Special Projects and Tasks as Assigned
        • Completion of any assigned projects timely, accurately and to the specifications of leadership.
        • Ability to articulate and communicate trend or other findings to various leadership personnel within the organization.
        • Ensure Daily/Weekly/Monthly assignments are handled accurately and timely.

      • Maintaining Daily Workflow
        • Manages and maintains assigned workflow queues according to department guidelines.
        • Follow appropriate policies and procedures with regards to handling of denials and all other assigned queues.
        • 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.








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