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Patient Billing Rep I

Patient Billing Rep I

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.

Job Summary

Location : Methodist Corporate Office Address : 825 S 169th St. - Omaha, NE Work Schedule : Mon - Fri, business hours Responsible for billing, electronic claims submission, follow up and collections of patient accounts.

Responsibilities

Essential Functions

  • 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 keeps leads and supervisors informed on issues 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.

    • 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.

    • 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 Follow Up with Third Party Payers

  • Full understanding of all necessary third party billing and follow up processes based on department specifications.
  • Full understanding of all necessary contract related requirements.
  • Leverages payer websites and necessary tools to streamline the follow up process.
  • Appropriate documentation in Source System when necessary.
  • Ability to interpret correspondence assigned for accurate handling.

    • Special Projects and Tasks as Assigned

  • Completion of any assigned projects timely, accurately and to the specifications of leadership.
  • Ensure Daily / Weekly / Monthly assignments are handled accurately and timely.

    • Maintaining Daily Workflow

  • Manages and maintains assigned workflow queues according to department guidelines.
  • 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.

    • Schedule

    Mon - Fri, business hours

    Job Description

    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.

    • Experience

  • Minimum of one (1) year prior experience in healthcare third party billing and / or claims processing preferred.
  • Prior exposure to UP04 and / or CMS1500 claim data normally acquired through work in a physician's office or other healthcare setting preferred.

    • License / Certifications

  • N / A

    • Skills / Knowledge / Abilities

  • 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 create and submit both original and corrected claims.
  • Ability to audit accounts and payer explanation of benefits (EOBs) to determine appropriate action.
  • 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 maintain a working knowledge of multiple system applications.

    • Physical Requirements

    Weight Demands

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

    • Physical Activity

  • Occasionally Performed (1%-33%) :

    • Balancing

  • Climbing
  • Carrying
  • Crawling
  • Crouching
  • Distinguish colors
  • Kneeling
  • Lifting
  • Pulling / Pushing
  • Reaching
  • Standing
  • Stooping / bending
  • Twisting
  • Walking
  • Frequently Performed (34%-66%) :

    • Hearing

  • Repetitive Motions
  • Seeing / Visual
  • Speaking / talking
  • Constantly Performed (67%-100%) :

    • Fingering / Touching

  • Grasping
  • Keyboarding / typing
  • Sitting

    • Job Hazards

  • Not Related :

    • Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)

  • Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)
  • Equipment / Machinery / Tools
  • Explosives (pressurized gas)
  • Electrical Shock / Static
  • Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc)
  • Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to
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