The Service Representative is responsible for the timely processing of any duties or activity affecting prompt monetary reimbursement to the hospital for services which it has rendered. This includes efficient billing of claims to patients and third party payers, timely follow-up/collection activity to accounts, and prompt response to customer requests and inquiries. Employees work extensively with parents, third party payers, state/federal/local governmental agencies, and physicians.
1. Completes accurate hard copy and electronic billing for all patient?s accounts and submits the billing within 48 hours of 'Final Bill' to the appropriate payer. Bills secondary and tertiary payers within 5 days of a primary payer's payment.
2. Processes late charges within 5 days of receipt.
3. Performs collection activity on accounts. May use Worklists for followup or daily denial reports. Each one uses different criteria for selection of accounts to work.
4. Researches, analyzes claims paid incorrectly and resolves for restitution.
5. Reviews payer rejections and makes corrections to resubmit claim as needed or bills the parent within 5 days or the rejection.
6. Initiates and processes all adjustments for third party payers within 5 days of request and documents the accounts as appropriate.
7. Works with internal auditor on third party payer audits to ensure coordination of efforts and maximum collection. Coordinates activities resulting from audit.
8. Coordinates claim and financial appeal information with governmental agency and third party payers to ensure maximum reimbursement for hospital services.
9. Identifies payer problems and initiates recommendations for solution to supervisor.
10. Acts as a liaison between the hospital and third party payers in resolving billing and reimbursement issues.
11. Attends conferences and inservices to stay up to date in knowledge of payer requirements and regulations for billing and reimbursement and incorporate data learned into the work being processed.
12. Serves on and contributes to various task forces within the department and/or hospital.
13. Maintains knowledge base to provide coverage for other areas when needed.
14. Performs other related duties as assigned.
INSURANCE FOLLOW-UP PREFERRED
1. High school diploma or GED, Associates degree preferred.
2. Minimum of 2-3 years experience in medical billing, claims follow-up and customer service.
3. Knowledge of medical terminology, various claim forms, third party contracts and payment patterns, CPT and ICD9 coding, and reimbursement regulations and policies of third party payers.
4. The ability to do data entry and work a calculator.
5. One year experience working on a mainframe computer. Experience using Outlook, Word and Excel.
6. Problem identification and problem solving skills are required.
7. Excellent interpersonal, verbal, and written communication skills.
8. Excellent organization skills and the ability to comprehend and follow written and verbal instructions.
Sitting Constantly (67-100%)
Typing on a keyboard Frequently (34-66%)
Standing/walking Occasionally (0-33%)
Able to independently lift up to 25 lbs. Occasionally (0-33%)