Patient Billing Rep I

Nebraska Methodist Hospital•Omaha, NE

11d•Onsite

About The Position

The Patient Billing Rep I is responsible for billing, electronic claims submission, follow-up, and collection of patient accounts. The role submits electronic and paper claims in accordance with department and payer guidelines; reviews and corrects claim data; prepares secondary and tertiary billings; and handles adjusted claims. The representative also manages patient and management referrals, audits patient accounts and payer explanations of benefits, follows up with third-party payers, and maintains assigned workflow queues and correspondence. Work is at the Methodist Corporate Office, 825 S 169th St., Omaha, Nebraska, Monday through Friday, 7:00 a.m. to 3:30 p.m. The position requires professional communication with patients, attorneys, health system staff, management, and payers; timely documentation in the Source System; and the ability to learn and maintain working knowledge of health system applications. The employee completes assigned daily, weekly, monthly, and special project work accurately and on time.

Requirements

High school diploma, GED, or equivalent required.
Ability to interpret UB04 and/or CMS1500 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 explanations of benefits to determine appropriate action.
Effective communication skills for handling inquiries from patients, attorneys, health system staff, and payers professionally.
Knowledge and understanding of accounting and business principles to accurately audit patient accounts.
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, normally acquired through enrollment in a secondary education institution or online classes through the American Health Information Management Association (AHIMA).
At least one year of prior experience in healthcare third-party billing and/or claims processing.
Prior exposure to UB04 and/or CMS1500 claim data, normally acquired through work in a physician's office or another healthcare setting.

Responsibilities

Submit electronic and paper claims as needed, following department and payer-specific guidelines.
Obtain appropriate explanations of benefits (EOBs) using health system resources.
Review billing scrubber claim-detail screens 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 UB04 and/or 1500 forms.
Submit adjusted UB04/837I and/or CMS1500/837P claims according to department and payer-specific guidelines.
Communicate professionally, use active listening, follow telephone etiquette, and keep leads and supervisors informed of identified issues.
Handle regular and escalated referrals accurately and promptly; document referrals and patient inquiries, follow up when necessary, and notify patients of final results.
Learn and maintain working knowledge of current health system applications.
Identify, obtain, and print medical records when needed to resolve denials or system edits.
Audit patient accounts and encounters, determine remaining balances, and update proration when needed to allocate dollars 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 with third-party payers in accordance with department and contract requirements, using payer websites and other tools, and document appropriately in the Source System.
Interpret assigned correspondence and handle it accurately.
Complete special projects and assigned daily, weekly, and monthly work accurately and on time.
Manage assigned workflow queues and process mail and correspondence according to department guidelines.
Document work promptly and appropriately in the Source System and maintain an understanding of work-item, state-based, and exception queues.