Professional Billing Claims Follow-up Rep II

SUBFUNCTION DEFINITION : Prepares and forwards patient claims to appropriate third-party payers. Analyzes and reviews claims to ensure that payer-specific billing requirements are met.

Follows up on billing, determines and applies appropriate adjustments, answers inquiries and updates accounts as necessary.

REPRESENTATIVE RESPONSIBILITIES

Billing

Compile and prepare patient charges. Prepare invoices billings, UB-04 and 1500 claim forms to be sent to 3rd party payers for payment indicating individual line items for services and total costs.

Review charges. Obtain and evaluate family, third party payers and agency resources for payment of charges. Managing patient billing and ensure procedures are billed according to contracts, transmit or mail all paper and claims, and review correspondence and follow up as needed.

Financial Support

Obtain and evaluate family, third party payers and agency resources for payment of charges. Counsel patient on third party coverage and present financial aspects.

Determine eligibility for State Medicaid, Social Security and other outside funding. Complete necessary paperwork for eligible patients, including medical and financial applications.

Coordinate inpatient and outpatient admissions. Coordinate information with the inpatient and outpatient charge systems.

Input charges and relative information. Manage accounts receivable data and collection information, ensure timeliness and accuracy.

Research third party payers and community physician charges in order to maintain usual and customary as will as competitive charges.

Check and update charge master. Conduct utilization review for the division from insurance companies and working in conjunction with Cincinnati Children's Utilization Review department.

Process, post, and balance payments to accounts timely, accurately, and in the correct period.

Systems Support

Maintain and update departmental system, including templates, and payer and physician information.

Collaboration

Act as a preceptor for new employees. Perform specialty services functions. Act as a resource within the department / division.

Provide instruction for performing non-routine functions. Serve as a liaison between Physicians Billing Service, Admitting, Outpatient Surgery, Outpatient

Department

Patent Financial Services and other Cincinnati Children's departments.

Quality

Provide Quality Assurance reports for the division.

Qualifications

EDUCATION / EXPERIENCE

Required :

• High school diploma or equivalent
• 2 years of work experience in a related job discipline.

Preferred : Unique Skills

Unique Skills

Cincinnati Children's is proud to be an Equal Opportunity Employer that values and treasures Diversity, Equity, and Inclusion.

We are committed to creating an environment of dignity and respect for all our employees, patients, and families (EEO / AA).

Professional / Non-Clinical

Shift

Day Job

Job Type

StandardDepartmentProfessional Billing Operation

Employee Status

Regular

Weekly Hours

Salary Range

17.59-24.73