Patient Account Rep - Prof Billing - FT - Days - Billing and Collection @ MV

Unit Specific Duties Listed Below

Billing

• Ensures claims are billed timely and accurately using the Hospital Claims Scrubber Tool and billing system. Resolves claim edits.

• Collaborates with departments to resolve applicable claim errors.

• Reports all unbilled claim information and issues that may delay billing to Management to ensure there is no adverse effect on Hospital Cash Collections or Accounts Receivable. 

Customer Service

• Receives and processes correspondence and phone or online inquiries from patients, payers or any other third party in a timely and professional manner.

• Resolves patient billing inquiries and processes patient payments over the phone or in person.

Follow Up

• Follows up on unpaid and denied claims for account resolution.

• Resolves accounts by contacting managed care entities, other third party payer organizations or patients to facilitate timely payments.

• Performs research and makes determination of appropriate actions for payment resolution. Writes and submits appeals for denied claims.

• Keeps informed of managed care and contractual arrangements to resolve accounts by managed care payers. 

• Assigns root causes to denials based on research.

Payment Posting

• Posts daily cash and adjustments for Hospital and Professional billing.

• Resolves undistributed payments and performs cash reconciliation.

• Reports all payment issues to Management to ensure there is no adverse effect on Hospital Cash Collections or Accounts Receivable. 

Self Pay Credit Balances

• Resolves credit balances that are due to patients.

• Audits and reconciles accounts to confirm credit balance and submits refunds in a timely manner.

Qualifications

• High School Diploma or equivalent.

• One year related work experience in a Hospital, Physician, or other healthcare setting.

• Strong verbal and written communication skills.

• Works in a collaborative and team manner.

• Efficient organizational skills and effective reasoning, problem solving and critical thinking skills.

• Excellent typing skills.

• Ability to multi-task and demonstrate effective time management.

• Preferred knowledge and use of Microsoft Products: Outlook, Word & Excel.

• Strong attention to detail.

• Ability to process a high volume of work.

Unit Specific Qualifications

Billing

• Knowledge of medical terminology and billing.

• Prior experience with facility billing or a similar role.

• Understands Medicare, Medi-Cal, HMO, PPO and 3rd party rules and regulations.

Customer Service

• Prior experience in a customer service setting.

• Preferred knowledge of health insurance coverages.

Follow Up

• Experience with claim processing and denial follow up and resolution.

• Knowledge of insurance appeal writing.

• Basic knowledge of contracting.

• Understands Medicare, Medi-Cal, HMO, PPO and 3rd party rules and regulations.

Payment Posting

• Preferred cash and adjustment posting background with regards to quality control of payments and transactions to financial system.

• 10-key preferred.

Self Pay Credit Balances

• 10-key preferred.

• Knowledge of basic accounting practices and procedures.

License/Certification/Registration Requirements

None required

Ages of Patients Served

This position will serve all age groups.