Patient Representative Biller

QUALIFICATIONS

Education

• High school graduate or equivalent

Experience/Skills

• Athena experience preferred
• Possesses knowledge of business office operations
• Understands third party billing requirements
• Understands Medicare/Medicaid inpatient and outpatient billing
• Strives for customer satisfaction when responding to all patient/customer inquires (internal customers)
• Experience using office equipment
• Adapts professionally to changes in procedures and/or workload
• Possesses excellent written and oral communication skills
• Works independently with little supervision
• Maintains concentration
• Remains committed to a “cross training” philosophy for all assigned tasks

Working Conditions

• Works in a well-ventilated, well-lit general office environment
• Works well under pressure with attention to time constraints

ROUTINE RESPONSIBILITIES

Behavioral Expectations

• Consistently complies with established Behavioral Expectations

Essential Duties

• Reviews, identifies, and corrects claims issues identified in inhouse hold and the claim scrubbing holds
• Sends clean, timely claims out on first billing
• Works reconciliation desktops to ensure upfront rejection of claims are processed and resubmitted to correct payer
• Reviews assigned outstanding accounts receivable by using ATB, queues, and payment reports
• Submits timely and accurate adjustments documenting activity in account
• Understands and manages denials, submitting timely disputes and appeals
• Follows up with insurance companies to ensure claims are processed and paid correctly according to contract
• Understands payor contracts and billing guidelines. revenue codes, cpt codes, modifiers, and payor-specific guidelines
• Investigates and reports claims denial trends with payer documentation for departments to review and establish action plan
• Provides back-up phone support to billing lines daily

Full time/Day shift

80 hours/Biweekly