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Patient Billing Rep II

Patient Billing Rep II

Methodist Health SystemOmaha, NE, US
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Billing Specialist

At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we serve and people we employ. We call it The Meaning of Care a culture that has and will continue to set us apart. It's helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient's needs, or giving a high five when a patient beats a disease or conquers a personal health challenge. We offer competitive pay, excellent benefits and a great work environment where all employees are valued! Most importantly, our employees are part of a team that makes a real difference in the communities we live and work in.

Location : Methodist Corporate Office

Address : 825 S 169th St. - Omaha, NE

Work Schedule : Mon - Fri, 8 : 00am to 4 : 30pm

Responsible for billing, electronic claims submission, follow up and collections of patient accounts.

Responsibilities

Essential Functions

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.

Display Effective Communication Skills

  • Demonstrates active listening skills.
  • Notifies and informs supervisor 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.

    • Handling of Referrals

  • 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.

    • Knowledge of System Applications

  • 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.

    • Auditing of Patient Accounts

  • 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.

    • Claim / Appeal Follow Up with Third Party Payers

  • 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.

    • Denial Trending and Analysis

  • 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.

    • Transaction Review / Posting

  • 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.

    • Special Projects and Tasks as Assigned

  • 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.

    • Maintaining Daily Workflow

  • 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.

    • Job Requirements

    Education

  • High school diploma, General Educational Development (GED) or equivalent required.
  • 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) preferred.
  • 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.

    • Experience

  • 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.
  • Prior experience interpreting contractual language preferred.

    • License / Certifications

  • N / A

    • Skills / Knowledge / Abilities

  • 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 inquires, 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.

    • Physical Requirements

    Weight Demands

  • Light Work - Exerting up to 20 pounds of force.

    • Physical Activity

  • Occasionally Performed (1%-33%) :
  • Balancing
  • Climbing
  • Carrying
  • Crawling
  • Crou