Patient Billing Rep I

Best Care•Omaha, NE

12d•Onsite

About The Position

The Patient Billing Rep I is responsible for billing patient accounts, submitting electronic claims, following up with third-party payers, and collecting account balances. The role handles electronic and paper claims according to department and payer guidelines; reviews billing-scrubber details and corrects claim information in the source system; prepares secondary and tertiary bills; and submits adjusted UB-04 and/or CMS-1500 claims. The representative also handles referrals and patient inquiries, audits accounts and benefit allocations, interprets payer correspondence, and maintains assigned work queues and related documentation. The position is based at the Methodist Corporate Office, 825 S 169th St., Omaha, Nebraska. The schedule is Monday through Friday, 7:00 a.m. to 3:30 p.m. The role requires professional communication with patients, attorneys, health system staff, management, and payers, along with the ability to learn and use current health system applications. Physical demands are classified as light work, with exertion of up to 20 pounds.

Requirements

High school diploma, GED, or equivalent required.
Ability to interpret UB-04 and/or CMS-1500 claim data to troubleshoot claim edits and resolve payer billing requirements accurately and promptly.
Ability to create and submit original and corrected claims.
Ability to audit accounts and payer EOBs to determine appropriate action.
Effective communication skills for professional interactions with patients, attorneys, health system staff, and payers.
Knowledge and understanding of accounting and business principles for accurate patient-account auditing.
Ability to follow up with third-party payers on claims and appeals to ensure timely and accurate processing.
Ability to maintain working knowledge of multiple system applications.

Nice To Haves

Coursework in coding, billing, or healthcare management, typically acquired through enrollment in a secondary education institution or online classes through AHIMA.
At least one year of prior experience in healthcare third-party billing and/or claims processing.
Prior exposure to UB-04 and/or CMS-1500 claim data, typically acquired through work in a physician’s office or other healthcare setting.

Responsibilities

Submit electronic and paper claims as needed according to department and payer-specific guidelines.
Obtain appropriate explanations of benefits (EOBs) using health system resources.
Review billing-scrubber claim details and ensure claim data is appropriate for submission.
Update and document claim corrections identified by the billing scrubber in the source system.
Prepare secondary and tertiary billings manually and electronically on UB-04 and/or CMS-1500 forms.
Submit adjusted UB-04/837I and/or CMS-1500/837P claims according to department and payer-specific guidelines.
Communicate effectively, demonstrate active listening, follow telephone etiquette, respond courteously, and keep leads and supervisors informed about identified issues.
Handle regular and escalated referrals promptly and accurately, document referrals and patient inquiries when necessary, and follow up with patients about final results.
Learn and maintain working knowledge of current health system applications.
Identify, obtain, and print medical records as needed to resolve denials or system edits.
Audit patient accounts, determine remaining balances, and update proration when necessary so dollars are allocated to the appropriate benefit orders.
Use available resources to complete account audits and document findings and actions in the source system when necessary.
Follow up on third-party claims according to department specifications and contract requirements, using payer websites and other tools and documenting actions when necessary.
Interpret assigned correspondence and handle it accurately.
Complete assigned projects and daily, weekly, and monthly tasks accurately, promptly, and to leadership specifications.
Manage assigned workflow queues and process mail and correspondence according to departmental guidelines.
Document work promptly and appropriately in the source system and maintain an understanding of work-item, state-based, and exception queues.