Billing Services Representative

Saint Peters Healthcare System•Piscataway Township, NJ

6d•$18 - $29

About The Position

The Billing Services Representative works in the Business Office to maintain account accuracy and ensure claims are reviewed and submitted cleanly and on time. The role monitors charges, modifiers, CPT-4s, HCPCS, payments, DRGs, and ICD-10 coding; reviews outstanding accounts using reports, queues, billing edits, and credit-balance information; and completes timely adjustments, notes, patient-balance transfers, and medical-record requests. The representative manages denials and administrative claim appeals, routes clinical denials and downgraded or billing-time-denied claims to the appropriate parties, and updates or corrects accounts with support from originating departments. The role works with management and other departments or payors to resolve issues, applies applicable billing and payor requirements, and follows departmental and hospital policies, including HIPAA and federal guidelines.

Requirements

At least one year of experience as a Medical Insurance Biller or in related responsibilities; hospital billing is strongly preferred.
Proficiency in Microsoft Word and Microsoft Excel.
High level of interpersonal skills necessary to lead others and work effectively with Patient Accounts Personnel and outside agencies.
Comprehensive knowledge of collections, accounts receivable follow-up, and billing.
Knowledge of third-party payers and state and federal agencies in relation to Patient Accounting.
Ability to consistently meet deadlines and concentrate on and pay attention to details for 75% of work time.
Knowledge of Medicare and Medicaid.

Nice To Haves

Hospital billing experience is strongly preferred.

Responsibilities

Ensure account accuracy.
Review daily claims to ensure submissions are clean and timely.
Monitor charges, modifiers, CPT-4s, HCPCS, payments, DRGs, and ICD-10 coding.
Review outstanding accounts using ATB, queues, payment reports, halt reports, electronic billing edits, and credit balances.
Submit timely and accurate adjustments, notes, patient-balance transfers, and medical-record requests.
Notify the management team of issues involving payors, departments, or other parties.
Resolve account issues and solve problems independently whenever possible.
Use the hospital information system, contract management system, electronic billing system, payer websites, and document imaging system.
Manage denials and appeal administrative claims; understand how denials should be handled.
Send clinical denials and downgraded claims to appropriate parties to ensure timely appeal.
Ensure claims denied at the time of billing are distributed to appropriate parties for review.
Update and correct accounts with assistance from originating departments, including charges, authorizations, and insurance issues.
Follow departmental and hospital policies and procedures, including HIPAA guidelines and federal guidelines.
Apply knowledge of payor contracts and billing guidelines, revenue codes, payor-specific requirements, and payor/plan codes.
Work with the management team and Patient Accounts Personnel, as well as outside agencies.