Billing Services Representative

Saint Peters Healthcare System•Piscataway Township, NJ

1d•$18 - $29•Onsite

About The Position

The Billing Services Representative will ensure account accuracy, review daily claims for clean and timely submissions, and monitor various billing components such as charges, modifiers, CPT-4s, HCPCS, payments, DRGs, and ICD-10 coding. This role involves reviewing outstanding accounts using various reports and systems, submitting adjustments and notes, and collaborating with the management team on payor and departmental issues. The representative will independently resolve account issues, utilize provided technology (hospital information system, contract management system, electronic billing system, payer websites, document imaging system), and manage denials by appealing administrative claims. They must understand denial reasons and ensure timely appeals by sending clinical denials and downgraded claims to appropriate parties. Additionally, claims denied at the time of billing need to be distributed for review. The role requires updating and correcting accounts with assistance from originating departments and adhering to departmental, hospital, HIPAA, and Federal guidelines. A strong understanding of payor contracts, billing guidelines, revenue codes, payor-specific requirements, and payor/plan codes is essential.

Requirements

Requires one (1) or more years experience as a Medical Insurance Biller or related responsibilities and Hospital Billing strongly preferred.
Proficient in Microsoft Word and Microsoft Excel.
Requires high level of interpersonal skills necessary to lead others and to work effectively with Patient Accounts Personnel as well as outside agencies.
Must possess a comprehensive knowledge of Collection, A/R follow-up and Billing.
Knowledge of third-party payers, State and Federal Agencies (constantly changing) with regards to Patient Accounting.
Requires the ability to consistently meet deadlines, to concentrate and pay attention to details 75% of work time.

Responsibilities

Ensure account accuracy.
Review daily claims to ensure submissions are clean and timely.
Monitor charges/modifiers/CPT-4s/HCPCS/payments/DRGs/ICD-10 coding.
Review outstanding accounts using ATB/queues/payments reports/halt report/electronic billing edits/credit balances.
Submit timely and accurate adjustments/notes/patient balance transfers and medical record requests.
Work with management team and notifying of notifying of issues that arise with payors/departments/etc.
Resolve account issues and problem solving independently whenever possible.
Use technology provided (including hospital information system, contract management system, electronic billing system, payer websites and document imaging system.)
Manage denials and appealing administrative claims.
Understand denials and how they should be handled.
Send clinical denials and downgraded claims to appropriate parties to ensure timely appeal.
Ensure claims denied at time of billing are distributed to appropriate parties for review.
Update and correct accounts with assistance of originating departments (charges/authorizations/insurance issues).
Follow departmental and hospital policy and procedure (this includes HIPAA guidelines and Federal guidelines).
Understand payor contracts and billing guidelines; revenue codes and payor specific requirements; and payor/plan codes.