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 timeframes
Bills all hospital services to primary insurer or patient correctly and within expected timeframe
Follows up with insurance companies on all assigned accounts within expected timeframe
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