Professional Billing Representative| Professional Billing, Full-Time
Professional Billing Representative| Professional Billing, Full-Time
Posted 5 days ago
SENIORITY
Senior
About the role
- Ensures insurance claims are sent timely and accurately to government, commercial and managed care plans, adhering to payer timely filing requirements
- Researches and resolves claim edits via Epic Work Queues (WQ) and/or external billing software, including electronic and paper processing
- Prepares and processes secondary and tertiary insurance claims completing coordination of benefit tables accurately reflecting prior payer reimbursement
- Ensures compliance and billing requirements for Worker's Compensation (WC) and third-party liability claims are met
- Ensures claims submission with all appropriate documentation, using the Release of Information (ROI) module in Health Information System (HIS)
- Verifies and updates patient account demographic and financial information, processing Real-Time Eligibility (RTE); contacting account guarantor and/or payer as appropriate for demographic and financial clarification
- Enters complete and appropriate account note(s) in HIS identifying actions taken to reconcile claims
- Works various hospital departments to ensure all authorizations, coding and charge information is in place to expedite clams processing and accurate account reimbursement
- Understands Medicare Common Working File (CWF) and how to determine primary payer based on Medicare Secondary Payer Questionnaire (MSPQ)
- Works in conjunction with various physician offices; providers and managers, to obtain billing and coding information
- Accounts Receivable Management:
- Manages account review and processing from system WQs, insures timely follow-up on all unpaid claims within appropriate billing cycle; manages system denial remark module, taking steps to rectify current denial
- Contacts payers via payer websites and telephone for claim status and/or clarification on denied claims
- Manages outstanding accounts receivable per departmental standards; maintains each payer's outstanding receivables at or above departmental established goals
- Prepares and submits appeals, collecting all pertinent documentation; filing per each individual payer's guidelines
- Customer Service:
- Supports all team members and co-workers, engaging in positive interactions at all times
- Exhibits behaviors reflective of Memorial's core values: Compassion, Accountability, Respect, Excellence, and Service
- Demonstrates regular and predictable attendance.
- Attends all mandatory education and in-services (i.e., team training, safety, infection control, etc.); completes mandatory health requirements.
- High school diploma or equivalent
- Three (3) years' experience in the medical field preferably in a hospital setting.
- Knowledge of revenue cycle functions, understanding of health insurance and government programs, billing processes, managed care contracts, coordination of benefits with ability to interpret explanation of benefits desired.
- Knowledge of office practices and procedures, medical terminology and the ability to communicate effectively. Must be proficient with Microsoft Word, Excel and PowerPoint.
- Medical Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- Flexible Spending Account
- Time Off:
Before you apply
Applying takes about a minute. These four things decide how fast it moves after that.
Your profile is current
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Two examples you can talk through
Not a portfolio — just two pieces of work where you can explain the decisions and what you'd change.
A number in mind
What you're on now and what would make you move. We negotiate better when we know both.
Your notice period
Employers plan around it, and it's the question that stalls offers most often.
Once you apply, someone reads it and calls you before anything reaches the employer — usually within two working days.
