Nebraska Methodist College ยท 5 months ago
Patient Billing Rep II
Methodist Corporate Office - Omaha, NE
Full-time
Onsite
Entry Level
1+ years expNebraska Methodist Health System is dedicated to providing exceptional care to the communities it serves. They are seeking a Patient Billing Rep II who will be responsible for billing, electronic claims submission, follow-up, and collections of patient accounts.
Higher Education
Responsibilities
UB04/837I and CMS1500/837P Claim Edit Handling/Billing/Interpretation
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 supervisor informed on denial and any other trends 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
Can effectively communicate in meetings/forums to a large or medium group of individuals
Works with supervisor to streamline process and decrease inefficiencies
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
Assists with testing and roll out plans to introduce new functionality within system applications used by the department
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 payer appeals, billing and follow up guidelines including specific time frames and possible form filing requirements
Leverages payer websites, automated tools and contract resources to streamline the follow up process
Appropriate documentation in Source System when necessary
Ability to interpret all appeal and follow up correspondence for accurate handling
Can clearly identify, trend and articulate patterns and issues from provided denials data
Can clearly provide alternative solutions with regards to denial findings
Leverage all necessary denial data sources as needed for trending and analysis
Leverage all necessary contract manager data sources and payer contracts as needed for reimbursement analysis
Has the ability to effectively network and communicate with outside department, payers, patients and any other necessary resources to resolve denial issues timely
Able to identify and correct transaction codes for proper write off classification
Accurate usage of transaction codes for efficient organizational reporting
Posts transactions within the departmental thresholds
Completion of any assigned projects timely, accurately and to the specifications of leadership
Ability to articulate and communicate trend or other findings to various leadership personnel within the organization
Ensure Daily/Weekly/Monthly assignments are handled accurately and timely
Manages and maintains assigned workflow queues according to department guidelines
Follow appropriate policies and procedures with regards to handling of denials and all other assigned queues
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
Demonstration of knowledge and practice in medical terminology, third party payer appeals, denial trending and analysis, ICD-9, ICD-10, CPT4/HCPCS Coding, UB04 and CMS1500 claim data as supported by the Patient Billing Rep Skill Set Examination required
Minimum of 1-2 years experience in a healthcare business office setting operating patient accounting software, electronic billing software and/or accessing payer websites required
Ability to create and submit both original and corrected claims
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 audit accounts and payer explanation of benefits (EOBs) to determine appropriate action
Ability to maintain a working knowledge of multiple system applications
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 review and clearly articulate denial trends and patterns to identify potential opportunity to prevent denials and maximize reimbursement
Preferred
Coursework in Coding, Billing or Healthcare Management normally acquired through enrollment in a secondary education institution or online classes through the American Health Information Management Association (AHIMA) preferred
Prior experience interpreting contractual language preferred
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