Patient Billing Rep II

* Demonstrates active listening skills.
* Notifies and keeps supervisor informed on denial and any other trends 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.
* Can effectively communicate in meetings/forums to a large or medium group of individuals.
* Works with supervisor to streamline process and decrease inefficiencies.
* 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.
* Assists with testing and roll out plans to introduce new functionality within system applications used by the department.
* Full understanding of all necessary third party payer appeals, billing and follow up guidelines including specific time frames and possible form filing requirements.
* Leverages payer websites, automated tools and contract resources to streamline the follow up process.
* Appropriate documentation in Source System when necessary.
* Ability to interpret all appeal and follow up correspondence for accurate handling.
* Can clearly identify, trend and articulate patterns and issues from provided denials data.
* Can clearly provide alternative solutions with regards to denial findings.
* Leverage all necessary denial data sources as needed for trending and analysis.
* Leverage all necessary contract manager data sources and payer contracts as needed for reimbursement analysis.
* Has the ability to effectively network and communicate with outside department, payers, patients and any other necessary resources to resolve denial issues timely.
* Completion of any assigned projects timely, accurately and to the specifications of leadership.
* Ability to articulate and communicate trend or other findings to various leadership personnel within the organization.
* Ensure Daily/Weekly/Monthly assignments are handled accurately and timely.
* 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.
* Demonstration of knowledge and practice in medical terminology, third party payer appeals, denial trending and analysis, ICD-9, ICD-10, CPT4/HCPCS Coding, UB04 and CMS
1500 claim data as supported by the Patient Billing Rep Skill Set Examination required.
* Minimum of 1-2 years experience in a healthcare business office setting operating patient accounting software, electronic billing software and/or accessing payer websites required.
* Prior experience interpreting contractual language preferred.
* Ability to create and submit both original and corrected claims.
* Skill in interpreting UB04 and/or CMS
1500 claim data to be able to troubleshoot claim edits and resolve payer billing requirements both timely and accurately.
* Ability to audit accounts and payer explanation of benefits (EOBs) to determine appropriate action.
* Ability to maintain a working knowledge of multiple system applications.
* 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 review and clearly articulate denial trends and patterns to identify potential opportunity to prevent denials and maximize reimbursement.
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