Billing and Follow-Up Representative-II (Hospital Follow-Up-Medicaid/HMO Payor-MI)- PFS (Remote)

Trinity Health•Farmington Hills, MI

1d•Remote

About The Position

Performs day-to-day billing and follow-up activities for an assigned Patient Business Services (PBS) location, supporting revenue operations for government and non-government accounts. The position works remotely and is part of a billing and follow-up team. It provides guidance and training to lower-level colleagues and helps resolve issues as needed. The role reports directly to a Supervisor Billing & Follow-Up. The representative performs billing and follow-up work to support the revenue cycle, documents claims billed, paid, settled, and followed up in appropriate systems, and identifies and escalates issues affecting accurate work. The role includes contacting payers about payments due, responding to correspondence, communicating with hospital departments to clarify discrepancies and obtain account information, investigating overpayments, underpayments, credit balances, and payment delays, and researching and correcting claim rejections. The representative may prepare reports and assists with colleague training. The position also requires compliance with applicable laws, regulations, and Trinity Health policies and standards of conduct.

Requirements

High school diploma, or an Associate's degree in Accounting, Business Administration, or a related field.
At least three years of direct experience and relevant knowledge of revenue cycle functions and systems in a hospital or clinic, health insurance company, managed care organization, or other healthcare financial services setting; qualifying work may include medical claims processing, financial counseling, financial clearance, accounting, or customer service, or an equivalent combination of education and experience.
Proficiency in Microsoft Office, including Outlook, Word, PowerPoint, and Excel.
Excellent verbal and written communication and organizational abilities.
Strong interpersonal skills for working with internal and external customers.
Accuracy, attention to detail, and time-management skills.
Ability to work independently and perform billing and follow-up activities promptly and accurately.
Comfort operating in a collaborative, shared-leadership environment.
Personal integrity, honesty, and caring, with the ability to inspire and motivate others in support of Trinity Health's philosophy, mission, vision, goals, and values.
Ability to set and organize work priorities, adapt to frequent changes, manage multiple tasks or projects, and work with people with diverse personalities and work styles.
Ability to comply with Trinity Health policies and procedures.

Nice To Haves

Experience in a complex, multi-site environment.
Completion of regulatory or mandatory certifications and skills-validation competencies.

Responsibilities

Perform daily billing and follow-up activities for an assigned PBS location as part of the revenue cycle team.
Document claims billed, paid, settled, and followed up in appropriate systems.
Identify and escalate issues affecting accurate billing and follow-up activities.
Contact payers about payments due on accounts and review and respond to mail correspondence promptly and accurately.
Communicate with hospital departments to clarify billing discrepancies and obtain demographic, clinical, financial, and insurance information.
Investigate overpayments, underpayments, credit balances, and payment delays.
Route tasks to appropriate workflows to maximize reimbursement and ensure claims are paid or settled accurately and promptly.
Research claim rejections, make corrections, take corrective actions, or refer claims to colleagues for resolution.
Follow up on delayed payments by contacting patients and third-party payers, determining the cause, and supplying additional data as needed.
Prepare special reports as directed by the supervisor, such as reports on claims and dollar amounts billed, edited, or unprocessed.
Assist with training and education for Billing and Follow-up Representative I colleagues, including on new systems, processes, or payers.
Provide problem resolution for billing and follow-up issues as needed.
Perform other duties as assigned by the supervisor.
Maintain working knowledge of applicable laws, regulations, compliance requirements, and organizational policies and procedures.
Demonstrate Trinity Health’s Mission, Vision, and Values in work behaviors, practices, and decisions.