Patient Finance Services Billing Representative, FT, Days

Prisma Health•Columbia, SC

6d•Onsite

About The Position

Provides accurate and timely submission of claims for Prisma Health to various payer sources according to filing guidelines. Follows up on specialty accounts, with increased focus on aged and high-dollar accounts, and researches payer variances by comparing expected to actual reimbursement. Partners with other departments to resolve issues such as missing payments, payer delays, and technical denials. Ensures insurance payments are correct and posted to the appropriate accounts, then reviews accounts to determine whether balances should move to a secondary payer or become patient liability. The role expedites billing functions, including resolving errors and claim edits that prevent billing, and processes daily paper claims for primary and secondary payers. It follows up on specialty accounts receivable, investigates rejections and denials, makes appropriate corrections and rebills claims, and escalates payer or internal issues in accordance with established guidelines. The representative also identifies recurring system and workflow problems, contacts payers, patients, or guarantors about delinquent accounts, and works toward timely resolution and payment. The representative is expected to meet daily productivity and quality goals, monitor and address quality issues, contribute to department goals, use time and resources effectively, support coworkers, and maintain professional relationships with external payers and internal departments in accordance with Prisma Health standards. This is a non-management role reporting to a supervisor, manager, director, or executive.

Requirements

High school diploma or equivalent, or post-high-school diploma/highest degree earned.
Three years of experience in hospital claims and billing follow-up.
Understanding of hospital and physician claim forms.
Knowledge of payer guidelines.
Maintain professional growth and development through seminars, workshops, in-service meetings, current literature, and professional affiliations.
Understand, promote, and adhere to compliance requirements, laws, and regulations.
Understand Prisma Health Standards of Behaviors.

Nice To Haves

CRCA preferred.
CRCR preferred.
Bachelor's degree and two years of hospital billing, follow-up, or denials may be considered in lieu of the stated minimum education and experience.
Communication skills preferred.
Attention to detail preferred.

Responsibilities

Submit claims accurately and promptly to payer sources in accordance with filing guidelines.
Resolve billing errors and claim edits that prevent account billing, and submit claims to the clearinghouse for electronic processing.
Process daily paper claim submissions for primary and secondary claims.
Follow up on assigned specialty accounts receivable to determine whether claims have been accepted, processed, paid, or denied.
Review claim rejections and rebill accounts when appropriate.
Identify root causes of non-payment denials and work with insurers, patients, and Prisma Health departments to resolve them and make necessary claim and account corrections.
Escalate accounts to payers and/or internally according to escalation guidelines to maintain acceptable accounts-receivable aging.
Identify recurring system issues that require workflow review or changes to support compliant billing.
Use appropriate tools to communicate with Prisma Health departments about errors requiring correction in their areas of responsibility.
Contact insurers, patients, or guarantors at established intervals to follow up on delinquent accounts, identify causes of delay, and expedite payment.
Compare expected and actual reimbursement, research payer variances, verify insurance payment amounts, and ensure payments are posted to the correct accounts.
Review accounts after payment posting to determine whether balances should be transferred to a secondary payer or assigned as patient liability.
Meet daily productivity and quality goals, monitor quality, identify root causes of quality problems, and take action to address them.
Contribute to department goals, use time and resources effectively, and assist coworkers as time allows.
Provide support to other team members and maintain effective relationships with external payers and internal departments.
Perform other duties as assigned.