Billing Representative | Patient Financial Services | Memorial Health

Memorial Health•Marysville, OH

About The Position

Memorial Health is seeking a Billing Representative to support its Patient Financial Services team. The role handles insurance claim submission and follow-up, account updates, denial resolution, appeals, and customer service. The representative works with payers, patients and guarantors, hospital departments, physician offices, providers, and managers to ensure claims are accurate, supported by appropriate documentation, and processed promptly. The position also supports compliance with billing rules, documentation standards, HIPAA requirements, and hospital and departmental policies. The role is scheduled for first shift, with 80 hours per pay period (every two weeks).

Requirements

High school diploma or equivalent.
Three years of experience in the medical field; hospital experience is preferred.
Knowledge of office practices and procedures and medical terminology.
Ability to communicate effectively.
Proficiency with Microsoft Word, Excel, and PowerPoint.
Ability to maintain confidentiality and comply with HIPAA privacy and security requirements.

Nice To Haves

Knowledge of revenue cycle functions.
Understanding of health insurance and government programs, billing processes, managed care contracts, coordination of benefits, and the ability to interpret explanations of benefits.
Medical experience in a hospital setting.

Responsibilities

Submit accurate insurance claims to government, commercial, and managed care plans within payer filing deadlines.
Research and resolve claim edits using Epic Work Queues and external billing software, including electronic and paper processing.
Prepare secondary and tertiary claims and complete coordination-of-benefits information reflecting prior payer reimbursement.
Meet billing and documentation requirements for Worker’s Compensation and third-party liability claims.
Submit claims with appropriate documentation using the Release of Information module in the Health Information System.
Verify and update patient demographic and financial information, process Real-Time Eligibility, and contact guarantors or payers for clarification as needed.
Enter complete account notes in the Health Information System describing actions taken to reconcile claims.
Coordinate with hospital departments to ensure authorizations, coding, and charge information are in place for claim processing and reimbursement.
Apply knowledge of the Medicare Common Working File and Medicare Secondary Payer Questionnaire to determine the primary payer.
Work with physician offices, providers, and managers to obtain billing and coding information.
Review and process accounts through system Work Queues and follow up on unpaid claims within the appropriate billing cycle.
Manage denial remarks and take steps to resolve denials; contact payers through websites or by telephone for claim status or clarification.
Manage outstanding accounts receivable according to departmental standards and established payer goals.
Prepare and submit appeals with pertinent documentation in accordance with each payer’s guidelines.
Provide professional, timely, helpful service to customers, family members, co-workers, vendors, and payers; listen actively and remain calm and confident when assisting others.
Address patient concerns and complaints, resolve issues when possible, and escalate more in-depth issues as appropriate for service recovery.
Seek opportunities to improve the department and personal and staff development, and maintain knowledge of developments in the field.
Follow hospital and departmental policies and procedures.
Support new employees and precept as needed; cooperate with co-workers and contribute to resolving workplace problems constructively.
Maintain patient confidentiality and comply with HIPAA privacy and security regulations.
Complete accurate documentation daily, avoid unapproved abbreviations, and follow hospital documentation and accreditation requirements.
Demonstrate Memorial Health’s core values of Compassion, Accountability, Respect, Excellence, and Service, along with a positive attitude and cultural awareness.
Maintain regular and predictable attendance and attend mandatory education and in-services; complete mandatory health requirements.
Follow the hospital’s and department’s Ethics and Compliance program and report compliance variances through the appropriate channels.
Perform other duties as required or assigned.