THIRD PARTY BILLING AND FOLLOW UP REPRESENTATIVE - PATIENT FINANCIAL SERVICE

JOB TITLE: Third Party and Follow Up Representative

DEPARTMENT: Patient Financial Service

LOCATION: John H. Stroger Jr. Hospital

SHIFT: 8:00 AM - 4:00 PM

Job Summary AFSCME 1178

The Third-Party Billing and Follow Up Representative facilitates the billing and collection processes of outstanding accounts receivable. Analyzes claims to determine compliant and accurate coding, charging; reviews file to confirm demographic and billing information is updated. Makes recommendations to improve billing and collection practices in an effort to decrease the reimbursement timeframe and accuracy of payment. Processes legal requests for information; ensures proper authorization is on file to support the request.

Typical Duties

• Facilitates the billing and collection processes of outstanding accounts receivable.
• Communicates with internal and external contacts to explain primary, secondary and tertiary billing, collection and resolution of claims including Medicare and other government and non-government accounts.
• Monitors daily queues for customer services/quality and productivity to maintain acceptable level as established by the departments, alerts management of high call volume patterns.
• Handles incoming and outgoing billing correspondence and phone inquiries relating to patient, third party administrators, attorneys, vendors and other insurance payers.
• Documents conversations and/or actions taken to support all claims inquiries, review and/or reconsiderations; streamlines the follow-up process of team members assisting on the file.
• Analyzes claims to determine compliant and accurate coding, charging; reviews file to confirm demographic and billing information is updated.
• Works to resolve any claim or billing concerns and takes appropriate action to escalate issues to management when appropriate.
• Develops relationships with patients, third party administrators, attorneys, vendors and other insurance payers.
• Performs follow-up processes on accounts to work towards a zero balance.
• Files a timely reconsideration or review of claim with supporting documentation such as a corrected claim, medical records and letter of explanation as necessary; communicates with departments to gather information needed to resolve the claim.
• Makes use of the software and hospital systems in accordance with hospital policies and procedures.
• Performs account system updates such as changes to financial class, eligibility status, payor contact information or rebills.
• Communicates with team members of any changes or updates that may impact workflow outcomes such as billing address or contact information.
• Performs balance transfers.
• Develops weekly productivity reports for management; makes recommendations to improve billing and collection practices in an effort to decrease the reimbursement timeframe and accuracy of payment.
• Processes legal requests for information; ensures proper authorization is on file to support the request.
• Maintains compliance with all billing and collections practices and regulations set forth by local and federal government and any other governing agencies to include but not limited to Center for Medicaid & Medicare Services (CMS), American Health Information Management Association (AHIMMA), Health Insurance Portability and Accountability Act (HIPAA), etc.
• Completes annual education requirements.
• Performs special projects and other duties as assigned.

Reporting Relationships

Reports to the System Supervisor of Third-Party Billing and Collections.

Minimum Qualifications

• High School Diploma or GED (must provide proof at time of interview)
• A minimum of One (1) year of experience in hospital third party billing and account follow-up is required.
• Current experience with a hospital revenue cycle system is required.

Preferred Qualifications

• A minimum of One (1) year of experience in hospital third party billing and account follow-up within a multi-hospital system is preferred.
• Bilingual English/Spanish or English/Polish is preferred.

Knowledge, Skills, Abilities and Other Characteristics

• Knowledge and familiarity with billing hierarchy levels and order of facilitation.
• Knowledge of compliance and regulations for billing and collection practices set forth by local and federal government and any other governing agencies.
• Knowledge of billing and collection processes in a hospital environment.
• Knowledge