Responsible for billing, electronic claims submission, follow up and collections of patient accounts.
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.
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.
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.
Light Work - Exerting up to 20 pounds of force.
Occasionally Performed (1%-33%):
Frequently Performed (34%-66%):
Constantly Performed (67%-100%):
Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)