Billing Services Representative

Saint Peter's Healthcare System•Piscataway, NJ

About The Position

The Billing Services Representative works in the Business Office to maintain account accuracy and ensure claims are submitted cleanly and on time. The role reviews claims, account activity, adjustments, denials, and outstanding balances, and works with management and originating departments to resolve account issues. The representative uses hospital and billing technology, follows hospital and departmental policies including HIPAA and federal guidelines, and applies knowledge of payer contracts, billing requirements, and Medicare and Medicaid rules.

Requirements

One or more years of experience as a Medical Insurance Biller or in related responsibilities; hospital billing experience 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 collection, accounts receivable follow-up, and billing.
Knowledge of third-party payers and State and Federal agencies as they relate to Patient Accounting.
Ability to consistently meet deadlines.
Ability to concentrate and pay attention to detail for 75% of work time.

Nice To Haves

Hospital billing experience.

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.
Work with the management team and notify them of issues involving payors, departments, and other parties.
Resolve account issues and problem-solve independently whenever possible.
Use the provided technology, including the hospital information system, contract management system, electronic billing system, payer websites, and document imaging system.
Manage denials and appeal administrative claims; understand denials and how they should be handled.
Send clinical denials and downgraded claims to appropriate parties to ensure timely appeal.
Distribute claims denied at the time of billing to appropriate parties for review.
Update and correct accounts with assistance from originating departments, including charge, authorization, 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.
Apply knowledge of Medicare and Medicaid requirements.