Billing & Insurance Representative

Employee Type:

Regular

Work Shift:

Day - 8 hour shift (United States of America)

Join Team Tidelands and help people live better lives through better health!

Position Summary:

Under the general supervisor of the Revenue Cycle Manager, the Billing and Follow Up Representative applies professional administrative knowledge and skill while providing accountable oversight of administration and financial systems, processes procedures and projects in the patient financial services area. The primary role is to protect the Accounts Receivable assets of Tidelands Health facilities by Billing & Collecting Insurance Claim Balance(s) and will be responsible for the following:

• Ensure accurate and complete account follow-up by demonstrating a thorough understanding of carrier-specific reimbursement as applicable to claim processing to include eligibility discrepancies, UB04 and/or 1500 claims form preparation, DRG, per diem, case rate, fee schedule reimbursements, etc.

• Conduct appropriate activity on accounts by contacting government agencies, third-party payors, and patients/guarantors via phone, e-mail, or online. Continue reimbursement activity until account resolve.

• Document all follow-up activity taken on an account in the patient account notes.

• Resolve claim processing issues on a timely basis by reviewing claim inventories, payments, and adjustments daily.

• Responsible for maintaining control of assigned inventory and ensure that daily productivity standards of accounts are met.

• Taking appropriate actions to ensure payments and adjustments have been posted properly as well as identify applicable. accounts for secondary billing and follow-up, where necessary.

• Research and document any correspondence received related to assigned accounts.

• Resolve account checks daily to ensure timely/accurate billing of patient account claims to the payers.

• Perform root cause analysis for issues that impact the collectability of patient account receivable balances and report issue with root cause and suggested opportunity for improvement to Revenue Cycle AR Manager.

• Assess accounts for balance accuracy, confirm correct payor billed, coding accuracy, denials, and outstanding insurance requests.

• Provide documentation appropriately and submit corrections; or if payor error, escalate for re-processing in a professional and timely manner.

• Request additional information from patients and payors as needed.

• Review payor overpayment letters as necessary per the Revenue Cycle AR Manager.

• Identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed.

• Identify payor issues and trends and escalate those issues to Lead and/or Management.

• Ensure compliance with State and Federal Law Regulations for Managed Care and other Third-Party Payors.

• Other duties and projects as assigned.

QUALIFICATIONS

Education:  

Must meet one of the following:

•  High School Diploma.

Experience/Knowledge/Skills:

Three or More Years of Experience with the following:

• Understanding of the Revenue Cycle process.

• Working with government agencies, third-party payors, and patients/guarantors via phone, e-mail, or online.

• Review of reimbursement activity until account resolved.

• Hands-on knowledge of UB-04 and/or HCFA 1500 billing and account follow up, CPT and ICD-10 coding and terminology for hospital and/or ambulatory/physician billing.

• Strong personal ability to work collaboratively among internal and external departments, to identify and help resolve enterprise-wide challenges.

• Solid understanding of HIPAA transaction sets and compliance with HIPAA privacy laws

• Documenting of all follow-up activity taken on an account in the patient account notes.

• Basic MS Office suite proficiency (Microsoft Excel, Word, and PowerPoint).

• Familiar with terms such as HMO, PPO, IPA, capitation and how these payors process claims.

• Demonstrated experience with having strong interpersonal communication skills required.

• Prior experience with interpreting and following detailed policies required.

• Demonstrated ability to independently think and make judgments in interpreting and adapting guidelines and making judgment decisions on specific problems required.

• Must pass PC typing test to demonstrate general PC aptitude and keyboarding ability at a minimum of 40 wpm required.

• Demonstrated Competency with