Billing Services Representative

Saint Peter's Healthcare System • Piscataway, NJ

69d • $18 - $28

About The Position

The Billing Services Representative will ensure account accuracy, review daily claims to ensure submissions are clean and timely, and monitor charges/modifiers/CPT-4s/HCPCS/payments/DRGs/ICD-10 coding. The representative will review outstanding accounts using ATB/queues/payments reports/halt report/electronic billing edits/credit balances and submit timely and accurate adjustments/notes/patient balance transfers and medical record requests. They will work with the management team and notify them of issues that arise with payors/departments, resolve account issues, and problem-solve independently whenever possible. The role requires the use of technology provided, including hospital information systems, contract management systems, electronic billing systems, payer websites, and document imaging systems. Additionally, the representative will manage denials and appeal administrative claims, understand how denials should be handled, and ensure claims denied at the time of billing are distributed to appropriate parties for review. They will update and correct accounts with the assistance of originating departments and follow departmental and hospital policy and procedure, including HIPAA guidelines and Federal guidelines. A comprehensive understanding of payor contracts and billing guidelines, revenue codes, and payor-specific requirements 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 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 notify them of issues that arise with payors/departments.
• Resolve account issues and problem-solve 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 appeal 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.
• Follow departmental and hospital policy and procedure including HIPAA guidelines and Federal guidelines.
• Understand payor contracts and billing guidelines; revenue codes and payor specific requirements.

Benefits

• Medical, dental, and vision insurance.
• Savings accounts.
• Voluntary benefits.
• Wellness programs and discounts.
• Paid life insurance.
• Generous 401(k) match.
• Adoption assistance.
• Back-up daycare.
• Free onsite parking.
• Recognition rewards.
• Fully paid tuition program or generous tuition assistance program.

What This Job Offers

• Job Type: Full-time
• Industry: Hospitals
• Number of Employees: 1,001-5,000 employees