Billing Representative | Patient Financial Services

Memorial Health Ohio•Paris Township, OH

2d•Onsite

About The Position

The Billing Representative will be responsible for ensuring insurance claims are sent timely and accurately to government, commercial, and managed care plans, adhering to payer timely filing requirements. This role involves researching and resolving claim edits, preparing and processing secondary and tertiary insurance claims, and ensuring compliance with billing requirements for Worker’s Compensation and third-party liability claims. The representative will also verify and update patient account information, enter account notes, and work with various hospital departments to ensure all necessary information is in place for claims processing and reimbursement. A key aspect of the role includes reviewing Medicare Common Working File to determine primary payer status.

Requirements

High school diploma or equivalent
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
Understanding of billing processes
Understanding of managed care contracts
Understanding of coordination of benefits
Ability to interpret explanation of benefits
Knowledge of office practices and procedures
Knowledge of medical terminology
Ability to communicate effectively
Proficient with Microsoft Word, Excel and PowerPoint

Nice To Haves

Knowledge of revenue cycle functions
Understanding of health insurance and government programs
Billing processes
Managed care contracts
Coordination of benefits
Ability to interpret explanation of benefits

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.