Billing FollowUp PT Acct

Summary

The Patient Accounts Representative

–Hospital Billing and Follow-up ensures the submission of timely and clean Inpatient/Outpatient claims to the various government/non-government payers and takes the appropriate action to resolve claim issues in order to accelerate cash collections.

Essential Duties and Responsibilities

These duties and responsibilities described below represent the general tasks performed on a daily basis; other tasks may be assigned.

• Submit Inpatient/Outpatient electronic and paper claims (UB-04 and 1500) to the appropriate government and non-government payers.

• Understand how to resolve Billing errors and/or warnings that are identified in the Patient Accounting and Billing System.

• Keep abreast of payer-specific and government requirements and regulations.

• Ensures claim information is complete and accurate in order to accelerate cash collections.

• Analyze information contained within the Patient Accounting and Billing system to make decisions on how to proceed with the billing of an account.

• Processes rejections by correcting any billing error and resubmitting claims to government and non-government payers.

• Place unbillable claims on hold and properly communicate to various Hospital departments the information needed to accurately bill.

• Process late charge claims in the event that charges are not entered in a timely fashion by Hospital Departments.

• Submit corrected claims in the event that the original claim information has changed for various reasons.

• Perform the billing of complex scenarios such as interim, self-audit, combined, and split billing etc.

• Limit the number of unreleased claims by reviewing all imported claims and either billing or holding the claim for further review.

• Meet Billing productivity and quality requirements as developed by Leadership.

• Measured on high production levels, quality of work output, in compliance with established CRH’s policy and standards.

• Record or generate revenue by gathering and processing information that impacts the patient revenue process.

• Review patient financial records and/or claims prior to submission to ensure payer-specific requirements are met.

• Keep abreast of payer-specific and government requirements and regulations

• Follow up on unprocessed or unpaid claims until a claims resolution is achieved

• Generates letters to insurance or patients as needed in order to resolve unpaid claim issues.

• Works on and maintains spreadsheets by sorting/adding pertinent data

• Analyze information contained within the billing systems to make decisions on how to proceed with the account.

• Work independently and has the ability to make decisions relative to individual work activities

• Identify comments in the billing systems by using initials and using approved abbreviations for universal understanding

• Keep documentation clear, concise, and to the point, while including enough information for a clear understanding of the work performed and actions needed

• Create appropriate documentation, correspondence, emails, etc. and ensure that they are scanned to the proper account for accurate documentation

• Read, understand, and explain benefits from all payers to coworkers, physicians, and patients

• Make phone calls, use the internet, and send mail to payers for follow-up on unprocessed claims, incorrectly processed claims, or claims in question

• Develop relationships with customers/patients/co-workers in order to gather and process information or resolve issues in order to receive accurate reimbursement and optimize internal and external customer satisfaction

• Post accurate adjustments as appropriate per billing policies and procedures, payer explanation of benefits, and the management directive

• Maintain work procedures pertinent to the job assignment

• Accountable for individual work activities

• Resolve questions that arise regarding correct charging and/or other concerns regarding services provided

• Complete cross-training, as deemed necessary by management, to ensure efficient department operations

• Report potential or identified problems with systems, payers, and processes to the manager in a timely manner.

• Complete special project assignments in a timely fashion

• Follows HIPAA guidelines in order to maintain strict confidentiality of all patient financial and hospital information at all times.

• Perform other duties as assigned