Patient Billing Rep II

Why work for Nebraska Methodist Health System
At Nebraska Methodist Health System we focus on providing exceptional care to the communities we serve and people we employ. We call it The Meaning of Care a culture that has and will continue to set us apart. Its helping families grow by making each delivery special conveying a difficult diagnosis with a compassionate touch going above and beyond for a patients needs or giving a high five when a patient beats a disease or conquers a personal health challenge. We offer competitive pay excellent benefits and a great work environment where all employees are valued! Most importantly our employees are part of a team that makes a real difference in the communities we live and work in.

Job Summary:

Responsibilities:

Essential Functions

UB04/837I and CMS1500/837P Claim Edit Handling/Billing/Interpretation

• All EDI and paper claims submitted are to be billed as needed following department and payer specific guidelines.
• Obtains appropriate EOBs through use of health system resources.
• Reviews Billing Scrubber Claim Detail Screens to ensure data is appropriate for claim submission.
• Ensure that claim corrections identified in billing scrubber are appropriately updated and documented in Source System.
• Prepares secondary and tertiary billings manually and electronically on UB04s and/or 1500s for accurate reimbursement.
• Submits adjusted UB04/837I and/or CMS1500/837P claims according to department and payer specific guidelines.

Display Effective Communication Skills

• Demonstrates active listening skills.
• Notifies and keepssupervisor informed on denial and any other trendsidentified.
• Follows telephone etiquette procedures set forth by the organization and/or individual department.
• Professional/Courteous responses when communicating with customers health system staff and management.
• Can effectively communicate in meetings/forums to a large or medium group of individuals.
• Works with supervisor to streamline process and decrease inefficiencies.

Handling of Referrals

• Timely and accurately handling of referrals both regular and escalated priority from management within department guidelines.
• Documents clearly and appropriately all referrals (including patient inquiries) in the Source System when necessary.
• If necessary follows up with patients on final results of inquiry both timely and professionally. Notifies patient of final results of account handling in question.

Knowledge of System Applications

• Demonstrates ability to learn and maintain a working knowledge on all the current health system applications.
• Identify/obtain/print medical records as necessary for resolution of denial or system edits according to department guidelines.
• Assists with testing and roll out plans to introduce new functionality within system applications used by the department.

Auditing of Patient Accounts

• Understand accounting and business principles to accurately determine the remaining balance on a given encounter.
• Upon accurately auditing encounter or visit is able to understand and update proration to make sure dollars are allocated to the appropriate benefit orders if needed.
• Leverages all needed resources to complete an audit of an account.
• Documents audit finding and actions taken in Source System when necessary.

Claim/Appeal Follow Up with Third Party Payers

• Full understanding of all necessary third party payer appeals billing and follow up guidelines including specific time frames and possible form filing requirements.
• Leverages payer websites automated tools and contract resources to streamline the follow up process.
• Appropriate documentation in Source System when necessary.
• Ability to interpret all appeal and follow up correspondence for accurate handling.

Denial Trending and Analysis

• Can clearly identify trend and articulate patterns and issues from provided denials data.
• Can clearly provide alternative solutions with regards to denial findings.
• Leverage all necessary denial data sources as needed for trending and analysis.
• Leverage all necessary contract manager data sources and payer contracts as needed for reimbursement analysis.
• Has the ability to effectively network and communicate with outside department payers patients and any other necessary resources to resolve denial issues timely.

Transaction Review/Posting

• Able to identify and correct transaction codes for proper write off classification.
• Accurate usage of transaction codes for efficient organizational reporting.
• Posts transactions within the departmental thresholds.

Special Projects and Tasks as Assigned

• Completion of any assigned projects timely accurately and to the specifications of leadership.
• Ability to articulate and communicate trend or other findings tovarious leadership personnel within the organization.
• Ensure Daily/Weekly/Monthly assignments are handled accurately and timely.

Maintaining Daily Workflow

• Manages and maintains assigned workflow queues according to department guidelines.
• Follow appropriate policies and procedures with regards to handling of denials and all other assigned queues.
• Mail/Correspondence processed and handled following departmental guidelines.
• Documents both timely and appropriately in Source System using proper documentation methods.
• Fundamental understanding of different work item state based and exception queues within the Patient Accounting System applications.

Schedule:

Mon Fri 8:00am to 4:30pm

Job Description:

Job Requirements

Education

• High school diploma General Educational Development (GED) or equivalent required
• Coursework in Coding Billing or Healthcare Management normally acquired through enrollment in a secondary education institution or online classes through the American Heath Information Management Association (AHIMA) preferred.
• Demonstration of knowledge and practice in medical terminology third party payer appeals denial trending and analysis ICD9 ICD10 CPT4/HCPCS Coding UB04 and CMS1500 claim data as supported by the Patient Billing Rep Skill Set Examination required.

Experience

• Minimum of 12 years experience in a healthcare business office setting operating patient accounting software electronic billing software and/or accessing payer websites required.
• Prior experience interpreting contractual language preferred.

License/Certifications

• N/A

Skills/Knowledge/Abilities

• Ability to create and submit both original and corrected claims.
• Skill in interpreting UB04 and/or CMS1500 claim data to be able to troubleshoot claim edits and resolve payer billing requirements both timely and accurately.
• Ability to audit accounts and payer explanation of benefits (EOBs) to determine appropriate action.
• Ability to maintain a working knowledge of multiple system applications.
• Ability to use effective communication skills in order to handle patient inquires attorneys health system staff and payers on a professional level.
• Knowledge and understanding of accounting and business principles to enable accurate auditing of patient accounts.
• Ability to follow up with the 3rd party payers for claims and appeals submitted to ensure timely and accurate processing.
• Ability to review and clearly articulate denial trends and patterns to identify potential opportunity to prevent denials and maximize reimbursement.

Physical Requirements

Weight Demands

• Light Work Exerting up to 20 pounds of force.

Physical Activity

• Occasionally Performed 133:
  • Balancing
  • Climbing
  • Carrying
  • Crawling
  • Crouching
  • Distinguish colors
  • Kneeling
  • Lifting
  • Pulling/Pushing
  • Reaching
  • Standing
  • Stooping/bending
  • Twisting
  • Walking
• Frequently Performed 3466:
  • Hearing
  • Repetitive Motions
  • Seeing/Visual
  • Speaking/talking
• Constantly Performed 67100:
  • Fingering/Touching
  • Grasping
  • Keyboarding/typing
  • Sitting

Job Hazards

• Not Related:
  • Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)
  • Physical hazards (noise temperature lighting wet floors outdoors sharps) (more than ordinary office environment)
  • Equipment/Machinery/Tools
  • Explosives (pressurized gas)
  • Electrical Shock/Static
  • Radiation Alpha Beta and Gamma (particles such as Xray Cat Scan Gamma Knife etc)
  • Radiation NonIonizing (Ultraviolet visible light infrared and microwaves that causes injuries to tissue or thermal or photochemical means)
• Rare 133:
  • Chemical agents (Toxic Corrosive Flammable Latex)
  • Mechanical moving parts/vibrations

About Methodist:

Nebraska Methodist Health System is made up of four hospitals in Nebraska and southwest Iowa more than 30 clinic locations a nursing and allied health college and a medical supply distributorship and central laundry facility. From the day Methodist Hospital was chartered in 1891 service to our communities has been a top priority. Financial assistance health education outreach to our diverse communities and populations and other community benefit activities have always been central to our mission.

Nebraska Methodist Health System is an Affirmative Action/Equal Opportunity Employer and does not discriminate on the basis of race color religion sex age national origin disability veteran status sexual orientation gender identity or any other classification protected by Federal state or local law.