Billing Representative

GENERAL STATEMENT OF DUTIES: Responsible for facilitation of patient billing and collection activities, following patient accounts through the billing process to the payor, working with the payor through claims processing, and ensuring reimbursement to the practice.

ESSENTIAL FUNCTIONS:

1. Reviews insurance denials and rejections to determine next appropriate action steps and obtain necessary information to resolve any outstanding denials/rejections.
2. Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
3. Verifies receipt of claim with insurance plans, determining the next appropriate action step.
4. Researches all information needed to complete billing process including obtaining information from providers, ancillary services staff and patients.
5. Assists patients and family members with billing and account questions including following up with insurance companies and internal departments as needed.
6. Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement from insurance payers.
7. Assumes full responsibility of reducing the accounts receivable of insurance balances by working through outstanding accounts.
8. Analyzes accounts for proper claims processing and payment posting through inquiries from patients or staff.
9. Communicates with insurance and collection agencies. Completes daily requests and working through obstacles on account balance to ensure maximum reimbursement.
10. Identifies and communicates trends and/or potential issues to Billing Supervisor.
11. Follows and maintains all LOS policies and procedures, including those specific to billing.
12. Maintains account receivables, identifying potential problems through registration, charge corrections, duplicate accounts and refunds.
13. Has an understanding of accounts receivable posting process for medical billing including: charges, payments and adjustments.

The job holder must demonstrate current competencies for job position.

EDUCATION: High school diploma or GED.

EXPERIENCE: Minimum two to three years of experience in medical billing. Must be able to communicate effectively with physicians, patients and the public and capable of establishing good working relationships with both internal and external customers.

REQUIREMENTS: None.

KNOWLEDGE:

1. Knowledge of the physician billing processes, ICD-10 and CPT coding.
2. Knowledge of computer systems.
3. Advanced computer knowledge, including Window based programs.

SKILLS:

1. Skill in customer service and an understanding of LOS' code of conduct.
2. Skill in using computer programs and applications including Microsoft Excel, Microsoft Word and Outlook.
3. Skill in establishing good working relationships with both internal and external customers.

ABILITIES:

1. Ability to multi task in a fast- paced environment. Must be detailed oriented with strong organizational skills.
2. Ability to understand patient demographic information and determine insurance eligibility.
3. Ability to work independently and demonstrate the ability to analyze data.

ENVIRONMENTAL/WORKING CONDITIONS: Normal office environment.

PHYSICAL/MENTAL DEMANDS: Requires sitting and standing associated with a normal office environment. Some bending and stretching required. Manual dexterity using a calculator and computer keyboard.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.