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Patient Account Rep II - Physician Billing Office

📁
Administrative/Clerical
📅
2018-R0179408 Requisition #
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GENERAL SUMMARY:

Adhere to corporate policies and procedures as dictated by the specific job.  Ability to interpret explanation of benefits and correspondence from multiple payers.  Contact payers, patients, or clinics to resolve claim issues.  Work accounts as dictated by the specific job.  Is knowledgeable with insurance carriers’ policies and procedures.  Adhere to all productivity expectations and quality assurance standards.  Provide excellent customer service consistent with Mercy’s philosophy and guidelines.  


ESSENTIAL FUNCTIONS:
Follow-up 
  • Responsible for reviewing, correcting and filing unpaid or previously adjudicated claims as assigned
  • Contacts insurance carriers, patients, and clinics to resolve claim issues.
  • Participates in recognizing denial trends and provides feedback to manager
 

Credit Balance (Insurance):

  • Research and resolve all insurance/business overpayments
  • Maintain knowledge of payment posting and follow-up processes
  • Review and respond to carrier correspondence requesting refunds
 

Credit Balance (Patient):

  • Research and resolve all patient credit balances
  • Communicate with guarantors and patients regarding questions related to patient refunds. 
  • Works unassigned payment queues and reports.
 
 

Cash/Zero Pay Posting

  • Responsible for the posting of all assigned cash payments, adjustments and remark codes,
  • Reconciles and balances all batches.
  • Contacts payers to resolve issues necessary in order to reconcile, apply payments, and bring variances to resolution. 
 

Customer Service:

  • Manages large amount of incoming calls and assists walk in customers
  • Handles customer complaints, provides appropriate solutions within time limits, and follows up to ensure resolution.
  • Follows communication procedures, guidelines and policies.
 
Collections:
  • Reviews and moves accounts through the pre-collection process before placing with collection agency
  • Handles inbound and outbound collection calls.
  • Is responsible for all bad address and legal correspondence, probates, and bankruptcy
 

Financial Assistance:

  • Reviews all  applications to determine if the account qualifies for charity
  • Is knowledgeable and adheres to the CHI Financial Assistance policy

MINIMUM KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:

  • High school diploma or GED required.
  • One year experience in accounts receivable, banking, or office setting required.
  • A minimum of one year current experience of CPT, ICD-10, and HCFA 1500 preferred.
  • Successful completion of a medical terminology class preferred.
  • One year 10 key experience preferred.
  • Demonstrates written, verbal, and nonverbal communication that is consistent with the Mercy Mission, Values and I Will Statements to all patients, families, visitors, medical staff, colleagues, vendors and other internal and external customers.
  • Must be a self- started and demonstrate the ability to work independently by making appropriate decisions according to the organizational and departmental guidelines that fall within the scope of the position.
  • Demonstrates the ability to understand and effectively utilize a highly complex billing system(s).
  • Maintains current knowledge of all Federal, State and compliance regulations related to billing and insurance preferred.
  • Demonstrates an understanding of HCFA 1500 claim forms, CPT, ICD.9 and HCPCS codes specific to insurance carrier requirements preferred.

About Us


Chances are, you’re here because you’re looking for a career offering greater opportunity, challenge and fulfillment. We’re confident you’ll find all three at CHI. As one of the nation’s largest nonprofit health systems, we offer a wealth of careers across more than 101 hospitals in 18 states. Our faith-based health system welcomes you to share in our mission of building healthier communities, whether as a surgeon in the operating room or an administrator in a conference room. When you work in a supportive environment with like-minded professionals, wonderful things happen. Learn More

Equal Opportunity Employment


Consistent with our Core Values, Catholic Health Initiatives employers are EEO/AA/M/F/Vets/Disabled Employers. Qualified applications will receive consideration for employement without regard to their race, color, religion, national origin, sex, sexual orientation, gender identification, protected veteran status, disabilitiy or any other legally protected characteristic. 

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