Job Category:

Revenue Cycle

Work Shift/Schedule:

8 Hr Morning - Afternoon

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary

The Accounts Receivable Billing Rep is responsible for accurate and prompt follow-up of unpaid or denied claims/charges. Rep is also responsible for providing outstanding customer service to both patients and staff members. Rep must be able to research difficult accounts and report any specific denial trends to management. Rep will be responsible for staying current with all assigned payer updates. 
 

Minimum Job Qualifications

• Licensure or other certifications:

• Educational Requirements: High School Diploma or GED

• Minimum Experience: Two (2) years of experience in Medical Physician billing, collections and/or reimbursement to include authorizations, charge entry, claims management, payment posting and accounts receivable.

• Other:

Preferred Job Qualifications

• Preferred Licensure or other certifications: CPC certification

• Preferred Educational Requirements:

• Preferred Experience:

• Other:

Job Specific and Unique Knowledge, Skills and Abilities

• Thorough knowledge and understanding of patient billing, billing transmission and electronic billing systems, including reimbursement knowledge of Medicare, Blue Cross, United Health Care, Medicaid, commercial insurance and HMO carriers

• Knowledge of medical terminology and ICD-9/CPT coding.  Demonstrate competency in coding CPT and ICD9 related to reimbursement

• Strong written and oral communication skills including the ability to work with other departments.  Demonstrate positive interpersonal relations in dealing with fellow employees, Supervisors, Physicians, Management so that productivity and positive employee relations are maximized

• Ability to interpret third party coverage, patient responsibility and evaluate a patient’s financial condition

• Knowledge of processes for billing professional services provided in the hospital and office setting. Knowledge of the appeals processes for different payers.

• Knowledge of electronic billing systems and EMR’s

• Ability to work and resolve problems independently and demonstrate task completion

• Demonstrate thorough knowledge and understanding of CBO Policies and Procedures as well as the NGHS handbook

• Demonstrate thorough understanding of Medicare and commercial waivers if pertinent to job

• Demonstrate competency in use and maintenance of computer equipment, printers, and telephone system and facsimile machines. Understand basic PC window applications.

Essential Tasks and Responsibilities

• Maintains current knowledge of third party, federal and state regulations, insurance coverage, rejection codes and billing requirements related to physician billing and follow-up. This is to be accomplished by attending related seminars, research, meeting with insurance reps and reading all memos/payer updates. 

• Ensures secondary billing on accounts with secondary liability; follow-up on any unpaid balances.

• Provides corrected data and resubmit claims as necessary.  

• Responds to patient and third party inquiries/complaints regarding patient accounts via telephone, mail or in person.  

• Maintains/improves productive third party relationships.

• Ensures that denied visits/services are appealed or processed to be written off if applicable.

• Reports possible write-offs to Practice/Billing Manager.  

• Works closely with other billing personnel and Practice/Billing Manager in following up on accounts.

• Works closely with other billing personnel and Practice/Billing Manager in following up on accounts.

• Reviews/analyzes patient accounts and take needed actions to resolve patient issues by executing adjustments, refunds, etc. from incoming/outgoing telephone calls or mail. 

• Provides the highest-level customer service to patients and other CBO or center staff by following through on phone calls, site questions/concerns and account inquiries.  Resolve patient complaints and requests regarding insurance billing and initiate accurate account adjustments. 

• Updates demographic and insurance information on patient accounts as needed.

• Keeps others in Central Business Office informed of third par