Patient Finance Services Billing Representative, FT, Days

Prisma Health•Columbia, SC

About The Position

Provides accurate and timely submission of claims for Prisma Health to various payer sources based on filing guidelines. Follows up on specialty accounts, focusing on aged and high-dollar accounts, and researches payer variances by comparing expected and actual reimbursement. Partners with other departments to address missing payments, payer delays, and technical denials. Ensures insurance payments are correct and posted to the right accounts, then reviews accounts to determine whether balances should move to a secondary payer or become patient liability. The role expedites billing functions, resolves billing errors and claim edits, submits electronic and paper claims, and follows up on specialty accounts receivable. It investigates denials and non-payment, works with payers, patients, and Prisma Health departments to resolve issues, and escalates accounts as appropriate. The representative also identifies recurring system issues, communicates errors to relevant teams, contacts payers and patients about delinquent accounts, and meets productivity and quality goals. This is a non-management position 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 to stay current in the field.
Understand, promote, and adhere to compliance requirements, laws, and regulations.
Understand the Standards of Behaviors.

Nice To Haves

CRCA certification preferred.
CRCR certification preferred.
Communication skills preferred.
Attention to detail preferred.
In lieu of the stated education and experience requirements: a bachelor's degree and two years of hospital billing, follow-up, or denials experience.

Responsibilities

Resolve errors that prevent accounts from billing and clear claim edits for electronic submission.
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, or denied.
Review claim rejections and rebill accounts when appropriate.
Identify the root cause of non-payment denials and work with insurance companies, patients, and Prisma Health departments to resolve them and make necessary claim and account corrections.
Escalate accounts to payers 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 teams about errors requiring correction.
Contact insurance payers, patients, or guarantors at established intervals to determine the reason for delays and expedite payment.
Meet daily productivity and quality goals; identify opportunities for improvement, monitor quality, investigate quality problems, and take ownership of corrective action.
Contribute to department goals and use time and resources effectively, assisting coworkers as time allows.
Provide support to other team members using knowledge of payers and maintain effective relationships with external payers and internal departments.
Perform other duties as assigned.
Comply with Prisma Health's purpose, Standards of Behavior, and applicable laws and regulations.