Billing Senior Representative - Remote

JOB SUMMARY 

Responsible for processing incoming requests from various departments to bill manual and electronic claims to ensure timely and complete collection of all dollars assigned. 

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Working knowledge of various billing processes and the ability to support answering team questions and training up team members. 
• Works closely with leadership to review reports, scrub inventory and escalate identified denial payor trends and training opportunities.
• Skillset to work across multiple markets and systems to provide inventory coverage.
• Proficient in building upon skills in a fast-paced environment and adaptable to change.
• Bill primary claims appropriately completing the billing requirements via electronic submission or paper claims including any attachment of required documentation.
• Properly submit claims to secondary and tertiary insurance companies with the appropriate Explanation of Benefits (EOB) attachments, if applicable.
• Complete subsequent billing to third party payors to include rebills, secondary billing and/or special billing.
• Fulfill paper billing payer requirements with submitting itemized statements, medical records, and any required forms to process the claim.
• Review billing editor for all edits on UB04 and 1500 claim forms types related to charges, coding and patient information prior to billing to minimize underpayment, denials, and re-bill attempts.
• Responsible for verifying correct insurance information is loaded into demographics using VI, account notes and related accounts as resources.  
• Responsible for routing accounts with needed updates for valid billing to the appropriate department or contact utilizing the workflow process.
• Review the editor and/or control ID for all unbilled accounts and/or rebill requests. Bill all late charges with proper billing codes, per Late Charge Workflow.
• Notate accounts with proper activity codes for workflow back to the facilities for review of unclean claims or to the appropriate department for next steps of claim workflow.
• Reviewing rejected claims to determine the cause and what the next appropriate steps are to resolve utilizing our available resources. Responsible for calling insurance company if rejection is unclear to determine next step needed for billing.
• Expectation to complete all assigned inventory daily provided by leadership and maintaining inventory goals.
• Maintain and abides by all billing policies and procedures, objectives, quality assurance programs and safety & compliance standards.

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Intermediate Microsoft Office (Word, Excel)
• Good verbal and written communication skills.
• Good data entry skills.
• Able to work in a fast-paced environment and complete high volume of claims daily handling multiple facilities

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment.  This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• High School diploma or equivalent.  Some college coursework in business administration or accounting preferred
• 1-2 years of experience in hospital billing or hospital collections required

PHYSICAL DEMANDS 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to sit and work at a computer terminal for extended periods of time

WORK ENVIRONMENT 

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Office Work Environment

As a part of the Tenet and Catholic Health