Apply on Employer Site

Prisma Health · 4 months ago

Patient Account Services Billing Rep, FT, Days

Maryville, TN

Full-time

Onsite

Mid Level

3+ years exp

Prisma Health is dedicated to transforming healthcare for the benefit of the communities they serve. They are seeking a Patient Account Services Billing Rep to ensure accurate and timely submission of claims to various payer sources while managing specialty accounts and resolving any billing issues that arise. The role involves collaborating with internal departments and external payers to ensure proper reimbursement for services rendered.

Health CareHospitalMedical

Responsibilities

Provides accurate and timely submission of claims for Prisma Health to various payer sources based on timely filing guidelines

Ensures specialty accounts are followed up on in a timely manner with increased focus on aged and high dollar accounts

Follows up and pursues identified payer variances after comparing expected to actual reimbursement received

Responsible for working with other departments when issues arise such as missing payments, payer delays, and technical denials

Ensures payment amount(s) from insurance carriers are correct and posted to accounts

Reviews accounts after payment posting to determine if balance needs moved to secondary payer or patient liability

Knowledge of payers and provides support to other team members as needed

Demonstrates exceptional relationships with external payers and internal departments in accordance with Prisma Health Standards of Behavior and Compliance

Works and processes the billing functions, including resolving the discharged not final billed/stop bill errors that prevented the account from billing, the resolution of claim edits in order to submit to claims clearinghouse for electronic submission

Processes the daily paper claims submissions for primary and secondary claims

Follows up on specialty accounts receivable (AR) accounts assigned to determine if the claim has been accepted and processed for payment or denied

Reviews claim rejections and re-bills accounts when appropriate

Effectively and timely identifies the root cause of non-payment denials and works with the insurance company, the patient and Prisma Health departments to find resolution to claim denials, making all necessary claim and account corrections to ensure the full reimbursement of services rendered

Escalates accounts both at the payer and/or internally when appropriate, as well as involving the patient appropriately in accordance with the Prisma Health escalation guidelines in order to keep AR aging at acceptable levels for payer issues

Identifies system issues through trending and repetitive actions that require workflow review or changes to resolve compliant billing

Utilizes proper tools to communicate with Prisma Health department teams on specific errors for corrections related to their area of responsibility

Contacts insurance payers, patients or guarantors at established intervals to follow-up on status of delinquent accounts, determines the reason of delay and expedites payment

Meets daily performance productivity and quality goals

Identifies areas for improvements

Monitors quality levels, finds root cause of quality problems and owns/acts on quality problems

Contributes to department goals

Effectively utilizes time and resources, assisting co-workers as time allows

Performs other duties as assigned

Qualification

Hospital billing experienceClaim submission knowledgePayer guidelines knowledgeCRCA certificationCRCR certificationCommunication skillsAttention to detail

Required

High School diploma or equivalent OR post-high school diploma/highest degree earned

Three (3) years in hospital claims and billing follow-up

Preferred

Bachelor's degree and 2 years of hospital billing, follow-up/denials

CRCA preferred

CRCR preferred

Understanding of the hospital and physician claim forms

Knowledge of payer guidelines

Maintains professional growth and development through seminars, workshops, in-service meetings, current literature and professional affiliations to keep abreast of latest trends in field of expertise

Understands, promotes and adheres to all matters of compliance with laws and regulations

Understands the Standards of Behaviors

Communication skills preferred

Attention to details preferred