SENIOR PATIENT RELATIONS REPRESENTATIVE - 40000958

Durham County•Durham, NC

71d•$40,528 - $68,849•Onsite

About The Position

This position supports the billing unit by performing accurate and timely billing and coding of medical and dental claims for all clinical programs in the local health department. Under the direction of the Billing Operations Supervisor, the employee follows established procedures, ensures compliance with HIPAA and state and federal regulations, and helps maintain correct documentation for efficient claim processing. Responsibilities include preparing and verifying claims, correcting errors, responding to payer requests, and assisting with billing needs for programs such as Family Planning, STD, Tuberculosis, Immunization, Refugee Health, Maternal Health, Nutrition, and Dental Services.

Requirements

Graduation from high school and demonstrated possession of the knowledge, skills, and abilities gained through at least two years of office assistant/secretarial experience; or an equivalent combination of training and experience.
Working knowledge of medical billing principles, payer reimbursement methodologies (including Medicaid, Medicare, and commercial insurance), and healthcare revenue cycle practices.
Knowledge of modern office methods, practices, and equipment
Knowledge of computer software and the ability to train others on the use of that software
Ability to understand and contribute to the process of creating policies and procedures
Effective customer service skills
General understanding of bookkeeping and accounting principles as they apply to billing, payment posting, accounts receivable, and reconciliation.
Familiarity with government budgeting and public health financial procedures, including reporting, auditing, and fee setting.
Excellent interpersonal skills and the ability to maintain effective working relationships with clinical teams, administrative staff, the public, and representatives from external agencies.
Clear and professional oral and written communication skills; able to present information effectively to staff and leadership.
Strong analytical skills with the ability to interpret billing regulations, identify and resolve issues, and apply relevant laws and payer policies.
Highly organized with the ability to prioritize tasks, manage competing deadlines, and adapt to changing programmatic or regulatory needs.
Proactive, flexible, and open to continuous learning and adopting new approaches to improve efficiency and meet departmental goals.

Nice To Haves

Experience using billing systems such as EPIC, Patagonia Health, or CureMD
Familiarity with NC Tracks, Availity, and other payer portals
Certified Professional Biller (CPB), Certified Professional Coder (CPC), and/or Certified Revenue Cycle Professional (CRCP)
Completion of a two-year program in health administration, business, accounting, or a related field with one year of responsible experience in billing or related work

Responsibilities

Accurate review, entry, and submission of self-pay and insurance billing for accuracy (i.e. diagnosis codes, CPT codes, modifiers, patient and provider information and payer specific billing requirements)
Processing electronic billing in EPIC
Researching and resolving claim issues, non-payments and denials correcting and resubmitting for payment
Identifying denials for trends; reporting any findings to appropriate staff
Processing accounts receivables
Tracking aging accounts via preparing and analyzing reports
Communicating directly with patients and payors to resolve any billing/claim issues
Correcting patient account errors
Processing refunds to patients and/or payers
Entering patient approved Presumptive Medicaid insurance coverage into EPIC