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Memorial Health Ohio · 2 months ago

Billing Representative | Patient Financial Services, Full-Time

Marysville, OH

Full-time

Onsite

Mid Level

3+ years exp

Memorial Health Ohio is seeking a Billing Representative to join their collaborative team. The role involves ensuring timely and accurate processing of insurance claims, managing accounts receivable, and providing excellent customer service to patients and payers.

Health CareHospital

Growth Opportunities

Responsibilities

Ensures insurance claims are sent timely and accurately to government, commercial and managed care plans, adhering to payer timely filing requirements

Researches and resolves claim edits via Epic Work Queues (WQ) and/or external billing software, including electronic and paper processing

Prepares and processes secondary and tertiary insurance claims completing coordination of benefit tables accurately reflecting prior payer reimbursement

Ensures compliance and billing requirements for Worker’s Compensation (WC) and third-party liability claims are met

Ensures claims submission with all appropriate documentation, using the Release of Information (ROI) module in Health Information System (HIS)

Verifies and updates patient account demographic and financial information, processing Real-Time Eligibility (RTE); contacting account guarantor and/or payer as appropriate for demographic and financial clarification

Enters complete and appropriate account note(s) in HIS identifying actions taken to reconcile claims

Works various hospital departments to insure all authorizations, coding and charge information is in place to expedite clams processing and accurate account reimbursement

Works directly with Charge Description Master (CDM) Coordinator to insure all implanted devices are accurate and included on the claim

Reviews Medicare Common Working File (CWF) to determine primary payer based on Medicare Secondary Payer Questionnaire (MSPQ), as appropriate

Manages account review and processing from system WQs, insures timely follow-up on all unpaid claims within appropriate billing cycle; manages system denial remark module, taking steps to rectify current denial

Contacts payers via payer websites and telephone for claim status and/or clarification on denied claims

Manages outstanding accounts receivable per departmental standards; maintains each payer’s outstanding receivables at or above departmental established goals

Prepares and submits appeals, collecting all pertinent documentation; filing per each individual payer’s guidelines

Supports all team members and co-workers, engaging in positive interactions at all times

Exhibits professional communication with customers, family members, co-workers, vendors and payers, by providing helpful assistance and responding timely to requests

Ensures active listening prior to responding, remains calm and confident when assisting others

Demonstrates a strong representation of Memorial Health’s values through attitude, actions and communications with others

Addresses patient concerns and complaints and provides resolution for readily resolved issues; escalates more in-depth issues as appropriate to assist with service recovery

Displays enthusiasm and resourcefulness in providing assistance

Actively looks for and creates opportunities to improve department, staff and personal development

Develops and demonstrates knowledge of current developments in field to maintain competency

Utilizes hospital and departmental policies and procedures

Acts as a resource for new employees and precepts as needed

All interactions are conducted in a professional manner

Demonstrates a positive attitude

Provides excellent customer service, facilitates quality care delivery and fosters an atmosphere of understanding cultural diversity

Communicates dissatisfaction with issues to direct supervisor; actively contributes to the solution of problems and refrain from promoting dissatisfaction among co-workers

Must be a team player; cooperate with co-workers to resolve conflict through one on one negotiation or with the assistance of the Director or their designee

Maintains confidentiality at all times to protect patient’s privacy and maintains HIPAA privacy and security regulations

Documents accurately (painting a complete picture providing directions to other health care providers); refrains from using unapproved abbreviations in written or computer documentation

Documentation is completed on a daily basis

Understands the importance of accurate completion of documentation and Hospital accreditation requirements and how it impacts hospital payment and certification programs

Exhibits behaviors reflective of Memorial’s core values: Compassion, Accountability, Respect, Excellence, and Service

Demonstrates regular and predictable attendance

Attends all mandatory education and in-services (i.e., team training, safety, infection control, etc.); completes mandatory health requirements

Employee performs within the prescribed limits of the hospital’s and department’s Ethics and Compliance program and is responsible to detect, observe and report compliance variances to their immediate supervisor, or upward through the chain of command, the Compliance Officer, or the hospital hotline

Performs other duties as required or assigned

Qualification

Billing processesHealth insurance knowledgeRevenue cycle functionsMedical terminologyMicrosoft Office proficiencyCustomer serviceHIPAA complianceCritical thinkingInterpersonal skillsDocumentation skills