Apply on Employer Site

Prisma Health · 1 month ago

Patient Finance Services Billing Representative, FT, Days

Columbia, SC

Full-time

Onsite

Mid Level

3+ years exp

Prisma Health is dedicated to transforming healthcare for the benefit of the communities they serve. The Patient Finance Services Billing Representative is responsible for the accurate and timely submission of claims to various payer sources, ensuring follow-up on specialty accounts, and resolving issues related to payments and denials.

Health CareHospitalMedical

Responsibilities

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 our Claims Clearinghouse for electronic submission. Also processes the daily paper claims submissions for primary and secondary claims. - 30%

Follows up on Specialty 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. - 25%

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. - 10%

Identify system issues through trending and repetitive actions that require workflow review or changes to resolve compliant billing. - 5%

Utilize proper tools to communicate with Prisma Health department teams on specific errors for corrections related to their area of responsibility. - 5%

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. - 5%

Must meet daily performance productivity and quality goals. Is attentive to detail and accuracy, is committed to excellence, looks for improvements continuously, monitors quality levels, finds root cause of quality problems and owns/acts on quality problems. Actively contributes to department goals. Effectively utilizes time and resources, assisting co-workers as time allows. Must be dependable. - 5%

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. - 5%

All policies and procedures will be strictly adhered to. HIPAA, security, dress code, etc. will be conscientiously followed. Understands, promotes and adheres to all matters of compliance with laws and regulations. High level demonstration of the Standards of Behaviors. - 5%

Communicates well both verbally and in writing, shares information with others & has good listening skills. - 5%

Qualification

Hospital claims experienceBilling follow-upPayer guidelines knowledgeFacility claims experienceCRCA certificationCRCR certificationCommunication skillsAttention to detail