Billing Representative | Patient Financial Services | Memorial Health

Memorial Health Ohio•Paris Township, OH

About The Position

Memorial Health is seeking a Billing Representative to join its Patient Financial Services team. The role handles insurance claim submission and follow-up, account and eligibility updates, appeals, and coordination with payers, patients, hospital departments, and physician offices. The representative also provides professional customer service, maintains accurate and confidential documentation, supports coworkers, and follows hospital policies, compliance requirements, and Memorial Health’s core values. The position works the first shift for 80 hours per pay period (every two weeks).

Requirements

High school diploma or equivalent.
Three years of experience in the medical field, preferably in a hospital setting.
Knowledge of revenue cycle functions, health insurance and government programs, billing processes, managed care contracts, coordination of benefits, and interpretation of explanations of benefits is desired.
Knowledge of office practices and procedures and medical terminology.
Ability to communicate effectively.
Proficiency with Microsoft Word, Excel, and PowerPoint.

Responsibilities

Submit government, commercial, and managed care insurance claims accurately and within payer filing deadlines.
Research and resolve claim edits through Epic Work Queues and/or external billing software, including electronic and paper processing.
Prepare and process secondary and tertiary claims and accurately complete coordination-of-benefits tables based on prior payer reimbursement.
Meet billing and compliance requirements for Workers’ 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 documenting actions taken to reconcile claims.
Coordinate with hospital departments to obtain authorizations, coding, and charge information needed for timely claim processing and accurate reimbursement.
Use 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 from system work queues and follow up on unpaid claims within the appropriate billing cycle.
Manage denial remark workflows and take steps to address denials.
Contact payers through websites and by telephone to obtain claim status or clarification on denied claims.
Manage outstanding accounts receivable according to departmental standards and payer-specific goals.
Prepare and submit appeals with relevant documentation according to payer guidelines.
Support coworkers and communicate professionally with patients, family members, vendors, payers, and colleagues.
Address patient concerns and complaints, resolve readily addressed issues, and escalate more complex issues for service recovery.
Seek opportunities to improve the department and personal development, maintain knowledge of current developments, and follow hospital and departmental policies.
Act as a resource for new employees and precept as needed; contribute constructively to resolving workplace problems and conflicts.
Protect patient privacy and comply with HIPAA privacy and security requirements.
Complete accurate daily documentation, avoid unapproved abbreviations, and understand documentation requirements related to hospital accreditation, payment, and certification.
Complete mandatory education, in-services, and health requirements, and maintain regular and predictable attendance.
Follow the hospital and department Ethics and Compliance program and report compliance variances through appropriate channels.
Perform other duties as required or assigned.