Self-Pay Biller, Hospital PFS, Full time

Community Hospital•Grand Junction, CO

6d•Onsite

About The Position

The Self-Pay Biller will be responsible for following up on assigned accounts within the billing systems, initiating proactive measures for account resolution, and researching/analyzing accounts and payments. This role ensures all conditions for payment receipt are met, including accurate charges, financial class, authorization, coding, eligibility, benefit coverage, and patient responsibility. The Biller will maintain detailed system notes, meet productivity standards, and respond promptly to inquiries from payers, patients, and other parties. They will also initiate contact with patients to establish payment arrangements, find third-party sponsorship, or begin the charity process, and prepare necessary correspondence. Issues will be elevated to the supervisor as appropriate. The role involves submitting claims and statements, preparing refund requests, reviewing reports to identify and correct denials/edits, and investigating potential Medicaid linkages. Additionally, the Biller will prepare write-off requests for denied claims that cannot be appealed and handle all correspondence, documentation, and files in a professional and confidential manner.

Requirements

High school diploma or equivalent.
One to three years related experience and/or training preferred.

Responsibilities

Follows up on all assigned accounts within the billing systems in accordance with pre-established goals.
Initiates proactive measures that result in account resolution.
Researches and analyzes accounts and payments; reverses balances to credit or debit if charges were improperly billed or if payments were incorrect.
Ensures that all conditions for payment receipt have been satisfied, which includes, but is not limited to, accurate charges and financial class, authorization/certification/information, claims address, ICD-10 and CPT-4 coding, patient insurance eligibility, patient benefit coverage, and patient responsibility.
Writes appropriate notes in the system for every account, including any action taken.
Meets daily and weekly productivity standards.
Responds timely and accurately to all incoming correspondence and inquiries from payers, patients, and other appropriate parties.
Initiates contact with patient, as necessary.
Initiates recommendations and action plans for resolving accounts.
Evaluates accounts to determine any write-offs or corrections required, including duplicate charges.
Handles in a professional and confidential manner all correspondence, documentation, and files.
Attempts to locate patient/guarantor through direct contact, letter, or other means.
Receives and answers inquiries or complaints concerning self-pay accounts; gathers information for timely resolution of issues.
Speaks with patient/guarantor to find third-party sponsorship, settlement, or to begin charity process.
Prepares correspondence to patient/guarantor, as necessary.
Establishes payment arrangements according to preset guidelines.
Elevates issues, as appropriate, to the supervisor.
Submits claims and/or statements for payments.
Prepares refund requests for any monies due to patient or insurance company.
Reviews various reports to identify denials and edits; corrects claims, suggests action plans to eliminate these denials/edits in the future, and determines appropriateness for appeal.
Prepares write-offs requests for denied claims which cannot be appealed.
Investigates the possibility of Medicaid linkage.