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Job Description Summary:

Description:

Job Summary

Processes and monitors billing and follow up of claims submitted for payment to insurance payors, governmental payors and state agencies.

Qualifications
High School Diploma or GED (Required)

Work Experience
2 - 3 years a structured business environment (Required)
2 - 3 years hospital, Physician office or insurance environment (Preferred)

Licenses and Certifications
Required Certifications/Licensures:
CPAR certification or must be obtained within two years of employment

Essential Functions
ATTENTION TO BILLING DETAIL - PATIENT ACCOUNT REP:
Prepares billing and follow ups on claims in a timely manner.
Performs accurate and timely billing and account reviews ensuring that accurate information has been reviewed before sending to applicable payors or state agencies.
Conducts account review ensuring accurate billing information, enters and revises information as needed prior to claim being submitted.
Prepares adjustment bills, rebills, reprints claims and/or other source documents.
Processes failed claims in biller work file according to carrier specific requirements.
Coordinates with concurrent review precert nurse and/or admitting staff on precertification requirements.
Prepares daily productivity reports.

CUSTOMER SERVICE - PATIENT CLAIM ISSUES:
Serves as liaison between patient, employer, and carrier in resolving claim issues.
Communicates with patient, employer and carrier regarding claim status.
Processes patient inquiry requests within 24 hours.
Assists with Customer Service coverage duties as need arises.

KNOWLEDGE OF BUSINESS OFFICE DEPARTMENT GUIDELINES AND PROGRAMS:
Demonstrates knowledge of ever changing payer guidelines and regulations, programs and machines used.
Demonstrates mastery of computer programs and office machines used. Strong Performance includes mastery of the following skills, tasks and behaviors.
Creates and maintains via account notes, all correspondence, whether written or verbal, including discussion with carriers, patients or guarantors. Scans correspondence into the ChartMaxx system.
Submits Medicare Credit Balance Report quarterly, necessary to ensure that Phoebe Putney Memorial Hospital remains compliant with CMS rules and regulation.
Attends seminars and education relating to Medicare, Medicaid and Commercial.
Attends and participates in hospital and departmental staff meetings.

DOCUMENTATION:
Documents and submits required information and data in a timely fashion.
Clearly and accurately documents designated processes, policies, products, service offerings, etc.
Ensures that documentation is tailored to expected readers / users.
Uses correct terminology.
Conforms to required style and format.

Additional Duties
Adheres to the hospital and departmental attendance and punctuality guidelines.
Performs all job responsibilities in alignment with the core values, mission and vision of the organization.
Performs other duties as required and completes all job functions as per departmental policies and procedures.
Maintains current knowledge in present areas of responsibility (i.e., self education, attends ongoing educational programs).
Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time.
Demonstrates competency at all levels in providing care to all patients based on age, sex, weight, and demonstrated needs.

For non-clinical areas, has attended training and demonstrates usage of age- specific customer service skills.
Wears protective clothing and equipment as appropriate.