Billing Representative | Patient Financial Services, Full-Time

Memorial Hospital Union County•Marysville, OH

58d•Onsite

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About The Position

We are looking for a Billing Representative to join our collaborative team at Memorial Health! What You'll Do:

Requirements

High school diploma or equivalent and three (3) years' experience in the medical field preferably in a hospital setting. Knowledge of revenue cycle functions, understanding of health insurance and government programs, billing processes, managed care contracts, coordination of benefits with ability to interpret explanation of benefits desired. Knowledge of office practices and procedures, medical terminology and the ability to communicate effectively. Must be proficient with Microsoft Word, Excel and PowerPoint.

Responsibilities

Ensures insurance claims are sent timely and accurately to government, commercial and managed care plans, adhering to payer timely filing requirements
Researches and resolves claim edits via Epic Work Queues (WQ) and/or external billing software, including electronic and paper processing
Prepares and processes secondary and tertiary insurance claims completing coordination of benefit tables accurately reflecting prior payer reimbursement
Ensures compliance and billing requirements for Worker's Compensation (WC) and third-party liability claims are met
Ensures claims submission with all appropriate documentation, using the Release of Information (ROI) module in Health Information System (HIS)
Verifies and updates patient account demographic and financial information, processing Real-Time Eligibility (RTE); contacting account guarantor and/or payer as appropriate for demographic and financial clarification
Enters complete and appropriate account note(s) in HIS identifying actions taken to reconcile claims
Works various hospital departments to insure all authorizations, coding and charge information is in place to expedite clams processing and accurate account reimbursement
Works directly with Charge Description Master (CDM) Coordinator to insure all implanted devices are accurate and included on the claim
Reviews Medicare Common Working File (CWF) to determine primary payer based on Medicare Secondary Payer Questionnaire (MSPQ), as appropriate.
Manages account review and processing from system WQs, insures timely follow-up on all unpaid claims within appropriate billing cycle; manages system denial remark module, taking steps to rectify current denial
Contacts payers via payer websites and telephone for claim status and/or clarification on denied claims
Manages outstanding accounts receivable per departmental standards; maintains each payer's outstanding receivables at or above departmental established goals
Prepares and submits appeals, collecting all pertinent documentation; filing per each individual payer's guidelines
Supports all team members and co-workers, engaging in positive interactions at all times
Exhibits professional communication with customers, family members, co-workers, vendors and payers, by providing helpful assistance and responding timely to requests.
Ensures active listening prior to responding, remains calm and confident when assisting others
Demonstrates a strong representation of Memorial Health's values through attitude, actions and communications with others
Addresses patient concerns and complaints and provides resolution for readily resolved issues; escalates more in-depth issues as appropriate to assist with service recovery
Displays enthusiasm and resourcefulness in providing assistance
Actively looks for and creates opportunities to improve department, staff and personal development
Develops and demonstrates knowledge of current developments in field to maintain competency
Utilizes hospital and departmental policies and procedures
Acts as a resource for new employees and precepts as needed
All interactions are conducted in a professional manner
Demonstrates a positive attitude
Provides excellent customer service, facilitates quality care delivery and fosters an atmosphere of understanding cultural diversity
Communicates dissatisfaction with issues to direct supervisor; actively contributes to the solution of problems and refrain from promoting dissatisfaction among co-workers
Must be a team player; cooperate with co-workers to resolve conflict through one on one negotiation or with the assistance of the Director or their designee
Maintains confidentiality at all times to protect patient's privacy and maintains HIPAA privacy and security regulations
Documents accurately (painting a complete picture providing directions to other health care providers); refrains from using unapproved abbreviations in written or computer documentation
Documentation is completed on a daily basis
Understands the importance of accurate completion of documentation and Hospital accreditation requirements and how it impacts hospital payment and certification programs
HIPAA privacy regulations and related procedures
CMS updates on patient rights
Exhibits behaviors reflective of Memorial's core values: Compassion, Accountability, Respect, Excellence, and Service
Demonstrates regular and predictable attendance.
Attends all mandatory education and in-services (i.e., team training, safety, infection control, etc.); completes mandatory health requirements.
Employee performs within the prescribed limits of the hospital's and department's Ethics and Compliance program and is responsible to detect, observe and report compliance variances to their immediate supervisor, or upward through the chain of command, the Compliance Officer, or the hospital hotline.
Performs other duties as required or assigned.