Self Pay Biller, Hospital PFS, PRN/Pool

Community Hospital•Grand Junction, CO

3d•Onsite

About The Position

This position is for a Self Pay Biller in the Hospital PFS department, working on a PRN/Pool basis. The role involves following up on assigned accounts, analyzing payments, ensuring conditions for payment receipt are met, and maintaining accurate system notes. The Biller will also handle correspondence, resolve patient inquiries, establish payment arrangements, and prepare claims and statements for payment. Additionally, the role includes reviewing reports for denials and edits, preparing write-offs, and investigating Medicaid linkage. The position requires a high school diploma or equivalent and preferred related experience.

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.