Billing Representative - Business Office

Summary:

Processes and enters billing information into database. Completes billing process and distributes billing information. Verifies insurance benefits and assists with referrals. May prepare checks and cash for deposits. Monitors accounts receivable to maintain appropriate levels and reviews payments to maximize reimbursement. Interacts with patients, insurance carriers, the Billing Department and practice associates concerning patient accounts. Performs all functions in a courteous and professional manner. Assures all appropriate licensure, certifications and/or accreditations are secured according to policy to include all credentialing issues related to the service.

Responsibilities:

• Coordinates all Insurance Authorizations for the service.
• Verifies and updates necessary information; enters patient demographics and insurance information into the computer.
• Review tickets for accuracy and completeness, determine appropriate fees for services rendered, calculate totals, collect appropriate amount from patients, properly record information. Responsible for posting hospital charges or other satellite services. Utilizes correct ICD9, CPT and HCPCS coding methods to determine the proper code for the services rendered.
• Processes payments received in person and by mail. Records, totals and prepares monies for deposit according to procedure.
• Handles collection efforts for all outstanding accounts including patient calls and sending correspondence. Takes necessary steps to establish acceptable payment schedules or refer appropriate accounts to collection agency.
• May post over-the-counter payments to accounts (or NSF checks) for outstanding balances, including discounts, adjustments and write-offs.
• Follows up to determine if payment arrangements are being met, contacts patients to resolve problems, responds to correspondence or telephone calls from patients about accounts.
• Follows up, either by telephone or in writing, with insurance companies and patients regarding the processing of outstanding claims and/or appeals.
• Reviews all Explanations of Benefits (EOBs) and initiates collection procedures for those with zero payments.
• Maintains NSF checks to ensure the applicable account is added back to accounts receivable, in accordance with NSF policies and procedures.
• Generates various reports necessary to manage accounts receivable, including denial reports, insurance follow up reports, NSF reports and month end reports.
• Educates staff on corrections, e.g. front-end entry errors in a positive, constructive manner.
• Identifies problem accounts and follows through to completion.
• Reviews EOBs to ensure proper reimbursement of claims and reports any problems, issues or payer trends to supervisor.
• Reviews credit balance reports for correct recipient of refund.
• Resolves patient billing complaints and questions, initiates adjustments as necessary.
• Helps fiscal management and other administrative staff in implementing cost effective policies and procedures for all areas including billing, insurance, fee schedules, credit/collections, purchasing, and data processing.
• Gathers and reports monthly and annual data for fiscal, statistical and planning purposes.
• Follows the CHRISTUS Health guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).
• Maintains strict confidentiality.
• Uses oral and written communication skills to effectively convey ideas in a clear, positive manner that is consistent with the CHRISTUS Health Mission.
• Maintains established policies, procedures, objectives, quality assurance, safety, environmental and infection control.
• Implements job responsibilities in a manner that is consistent with the CHRISTUS Health Mission and Values.
• Performs other related work as required.

Requirements:

Education/Skills

• High school diploma or GED

Experience

• 2 years experience in physician practice
• 3 years accounts receivable experience
• Knowledge of billing and coding

Licenses, Registrations, or Certifications

• N/A

Work Type:

Full Time

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