Business Services Representative

The Business Service Representative works under the direction of the Business Service Manager. Job duties include review of services provided to determine accuracy; posting all charges, adjustments, and submitting claims to all parties responsible for payment; processing claim for payment; posting payments to the appropriate accounts; reconciling denials, verifying coverage; updating insurance profiles; follow-up of unpaid claims; assists with maintenance of data files; and, other duties, as assigned.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

1. Supports and implements the organization’s vision, mission and value.
2. Determines priorities and method of completing daily workload to insure that all responsibilities are carried out in a timely manner.
3. Performs all job functions in a professional and courteous manner. This includes answering all general phone calls timely. Provide excellent customer service to internal and external customers by being responsive to all inquiries in a timely manner.
4. Fosters and promotes a culture of service excellence and accountability.
5. Reviews assigned pending charges to validate accuracy of responsible party, charges (CPT), and diagnosis (ICD)
6. Review electronic health and dental systems for charge and diagnosis verification. Communicates electronically with provider of service for missing charges and/or clarity of diagnosis
7. Posts all transactions to include charges, adjustments, insurance and patient payments and reconciles postings to the General Ledger. Resolves credit balances via adjustments and/or refund
8. Receives, reviews, processes, and submits physician claims for payment in accordance to established guidelines.
9. Reviews and edits claims listed in the electronic insurance batch system to insure accuracy and transmits same to the insurance carrier(s) for payment.
10. Reviews payment denials, underpayments, and payment take backs for appropriateness and produce resolution by resubmission to the insurance carrier, patient billing, or appropriate adjustment.
11. Verifies patents coverage via electronic media and document review prior to billing and based on eligibility denial. Update patient insurance profile and claims as needed.
12. Reviews patient accounts post -payment and bills secondary insurance carrier when applicable.
13. Performs follow-up of unpaid claims via electronic media or telephone.
14. Prepares and submits requests for payment statement for patient responsibly. Assigns unpaid accounts to Bad Debt when collection efforts are exhausted.
15. Assists Business Service Management with maintenance of data files necessary to perform tasks.
16. Performs as a resource with other departments as it relates to issues of insurance coverage and eligibility.
17. Complies with organizational policies and procedures.
18. Performs all other duties as assigned.

EDUCATION/EXPERIENCE:

1. High School Diploma or equivalency and three years of medical billing experience required.
2. Must demonstrate a clear understanding of medical terminology, Current Procedural Terminology (CPT) and International Classification of Disease (ICD) coding.
3. Working knowledge of billing for a multi-discipline practice and general computer systems required.

OTHER SKILLS AND ABILITIES

1. Demonstrates ability and flexibility to work in other areas of the organization as n