PATIENT ACCOUNT REPRESENTATIVE II/BILLER

FLSA Status

Job Role Summary

The Patient Account Representative II/Biller provides timely and accurate billing to facilitate optimized reimbursement, research, and performance improvement initiatives.  This includes the verification of billing data for accuracy and completeness, following regulatory requirements, and in order to resolve edits or exceptions detected during system processing of the claim in the patient account system, claim editing system or the payor, reviewing the medical, facility protocol, other applicable documentation, and the understanding of payor denials, appeal, process, and credit balances.

Essential Functions and Responsibilities

• Responsible for the resolution of credit balances that have an outstanding low balance for hospital accounts, in compliance with Federal and State regulatory guidelines for timely turnaround of resolution.
• Serves as a resource to other departments to resolve problems and expedite billing and collection processes
• Responsible for resolving claim edits for low dollar hospital accounts while adhering to payor guidelines and regulations
• Responsible for identifying and trending payor rejections and denials, and also implements system process improvements to prevent future rejections and denials
• Answers e-mails and voicemails on a timely basis
• Aide and assist on special projects, including providing coverage for team members who are out of the office
• Keeps up to date on account billing and collection rules and regulations, contract terms, and conditions with regards to timely filing and service pre-certifications and authorizations
• Makes phone calls to patients and insurance companies to obtain information required to resolve patient accounts
• Updates job knowledge by participating in educational opportunities; reading professional publications.
• Works efficiently under pressure, acts independently, and accepts responsibility for decisions
• Participates in monthly staff meetings to educate new payor habits and etc. as needed
• Completes payor appeals based on under payment, timely filing, medical necessity, and prior authorizations
• Works proactively with departments, and resolves billing and/or issues; resolves Do Not Bill (DNB) errors and warnings, claim edit resolution.
• Review and maintain AR denials to ensure KPI measurements are met and/or exceeded; KPI’s are as follows: maintain AR days under 35, days in credit balance less than 1 day of AR, days in denial less than 1 day of AR, and outstanding claims are billed within 7 days of erroring out in the system
• Works with management when contract variances are identified
• Works assigned patient accounts in a credit balance and claims to resolution
• Performs accurate data entry for required information in the various management systems
• Completes refund packet within the OnBase imaging system
• Maintains weekly Excel spreadsheet of refunds processed
• Researches and resolves issues with balancing and posting of patient revenue within multiple systems
• Reconciliation of all transactions within the patient accounting system

Job Requirements

• Associate degree in business-related field preferred
• Two years of accounts receivable experience in a hospital billing environment or two to three years in a financial institution, may be accepted in lieu of formal education
• Previous denial management with Medicare, Medicaid, and Insurance is a plus
• Previous experience with billing Medicare, Medicaid, and Insurance is a plus
• Medical billing and coding certification a plus

Knowledge, Skills & Abilities

• In depth knowledge and the ability to translate code set for billing of federal, state and regulatory laws.  The ability to follow Eskenazi Health Services policies and procedures, and of Indiana State Department of Health regulations 
• Ability to utilize support systems such as Epic, Onbase, NThrive, and/or other software applications
• Knowledge of Epic Patient Accounting system
• Ability to use computer –key entry and operate a calculator
• Extensive knowledge of and ability to research and identify payor billing and reimbursement guidelines
• Excellent oral and written communication skills with the ability to present information to groups of clinical and non-clinical staff Ability to lead, supervise and motivate personnel 
• Excellent customer service skills 
• Ability to act professionally, be team oriented, and take solution-driven approaches to problem solving for all types of issues
• High level of professionalism and ethical behavior
• Knowledge of reimbursement methodologies, payor coverages, State/Federal programs providing healthcare benefits and payments
• Knowledge of assigned payer(s) billing requirements and regulations
• Ability to learn software quickly and interpret instruction manuals
• Must be capable of completing tasks within given time frames and be productive and goal oriented
• Ability to work independently and within a team with instructions and to deal with problems effectively in collaboration with peers and staff
• Ability to quickly learn and use payer and hospital patient accounting systems
• Possess knowledge of Health Care Procedure Codes and Uniform Billing standards
• Ability to multi-task in a fast paced environment
• High level of interpersonal, problem solving, and analytical skills