Nebraska Methodist College · 3 months ago
Patient Billing Rep I
Methodist Corporate Office - Omaha, NE
Full-time
Onsite
Entry Level
1+ years expNebraska Methodist Health System focuses on providing exceptional care to the communities they serve. The Patient Billing Representative I is responsible for billing, electronic claims submission, follow up and collections of patient accounts.
Higher Education
Responsibilities
All EDI and paper claims submitted are to be billed as needed following department and payer specific guidelines
Obtains appropriate EOB's through use of health system resources
Reviews Billing Scrubber Claim Detail Screens to ensure data is appropriate for claim submission
Ensure that claim corrections identified in billing scrubber are appropriately updated and documented in Source System
Prepares secondary and tertiary billings, manually and electronically on UB04's and/or 1500's for accurate reimbursement
Submits adjusted UB04/837I and/or CMS1500/837P claims according to department and payer specific guidelines
Demonstrates active listening skills
Notifies and keeps leads and supervisors informed on issues identified
Follows telephone etiquette procedures set forth by the organization and/or individual department
Professional/Courteous responses when communicating with customers, health system staff and management
Timely and accurately handling of referrals, both regular and escalated priority from management, within department guidelines
Documents clearly and appropriately all referrals (including patient inquiries) in the Source System when necessary
If necessary, follows up with patients on final results of inquiry both timely and professionally. Notifies patient of final results of account handling in question
Demonstrates ability to learn and maintain a working knowledge on all the current health system applications
Identify/obtain/print medical records as necessary for resolution of denial or system edits according to department guidelines
Understand accounting and business principles to accurately determine the remaining balance on a given encounter
Upon accurately auditing encounter or visit, is able to understand and update proration to make sure dollars are allocated to the appropriate benefit orders if needed
Leverages all needed resources to complete an audit of an account
Documents audit finding and actions taken in Source System when necessary
Full understanding of all necessary third party billing and follow up processes based on department specifications
Full understanding of all necessary contract related requirements
Leverages payer websites and necessary tools to streamline the follow up process
Appropriate documentation in Source System when necessary
Ability to interpret correspondence assigned for accurate handling
Completion of any assigned projects timely, accurately and to the specifications of leadership
Ensure Daily/Weekly/Monthly assignments are handled accurately and timely
Manages and maintains assigned workflow queues according to department guidelines
Mail/Correspondence processed and handled following departmental guidelines
Documents both timely and appropriately in Source System using proper documentation methods
Fundamental understanding of different work item, state based and exception queues within the Patient Accounting System applications
Qualification
Required
High school diploma, General Educational Development (GED) or equivalent required
Skill in interpreting UB04 and/or CMS1500 claim data to be able to troubleshoot claim edits and resolve payer billing requirements both timely and accurately
Ability to create and submit both original and corrected claims
Ability to audit accounts and payer explanation of benefits (EOBs) to determine appropriate action
Ability to use effective communication skills in order to handle patient inquiries, attorneys, health system staff and payers on a professional level
Knowledge and understanding of accounting and business principles to enable accurate auditing of patient accounts
Ability to follow up with the 3rd party payers for claims and appeals submitted to ensure timely and accurate processing
Ability to maintain a working knowledge of multiple system applications
Preferred
Coursework in Coding, Billing or Healthcare Management normally acquired through enrollment in a secondary education institution or online classes through the American Heath Information Management Association (AHIMA)
Minimum of one (1) year prior experience in healthcare third party billing and/or claims processing
Prior exposure to UP04 and/or CMS1500 claim data normally acquired through work in a physician's office or other healthcare setting
Benefits
Competitive pay
Excellent benefits
Company
Nebraska Methodist College
Established in 1891, Nebraska Methodist College is a private, fully accredited nursing and healthcare professions college and an affiliate of Methodist Health System.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Sarah Murphy
Chief Student Officer & Dean of Students
Company data provided by crunchbase