Business Services Representative - Temporary

SUMMARY:

The Business Services Representative (BSR) works under the direction of the Business Services Supervisor. The BSR is responsible for reviewing services provided to determine accuracy posting all charges adjustments and submitting claims to all parties responsible for payment. Additionally the Business Services Representative processes claims for payment posts payments to the appropriate accounts reconciles denials verifies coverage updates insurance profiles follows up on unpaid claims and assists with maintenance of data files.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

1. Supports and implements the organizations vision mission and values.
2. Determines priorities and methods of completing daily workload to ensure that all responsibilities are carried out in a timely manner.
3. Performs all job functions in a professional and courteous manner. This includes answering all general phone calls and email timely and providing excellent customer service to internal and external customers.
4. Fosters and promotes a culture of service excellence and accountability.
5. Reviews assigned pending charges to validate accuracy of responsible party charges (CPT) and diagnosis (ICD).
6. Reviews electronic health and dental systems for charge and diagnosis verification. Communicates electronically with providers of service for missing charges and/or clarity of diagnosis.
7. Posts all transactions to include charges adjustments insurance and patient payments and reconciles postings to the general ledger. Resolves credit balances via adjustments and/or refunds.
8. Receives reviews processes and submits Gracelight Community Healthgrant hospital and/or physician claims for payment in accordance to established guidelines.
9. Reviews and edits claims listed in the electronic insurance batch system to ensure accuracy and transmits same to the insurance carrier(s) for payment.
10. Reviews payment denials underpayments and payment take backs for appropriateness and resolves them by resubmission to the insurance carrier patient billing or appropriate adjustment.
11. Verifies patients coverage via electronic media and document review prior to billing and based on eligibility denial. Updates patient insurance profile and claims as needed.
12. Reviews patients accounts post -payment and bills secondary insurance carrier when applicable.
13. Performs follow-up of unpaid claims via electronic media or telephone.
14. Prepares and submits requests for payment statement for patient responsibly. Assigns unpaid accounts to Bad Debt when collection efforts are exhausted.
15. Assists Business Service Management with maintenance of data files necessary to perform tasks.
16. Performs as a resource with other departments as it relates to issues of insurance coverage and eligibility.
17. Complies with organizational policies and procedures.
18. Must be willing and able to work at all locations as needed to meet patient care needs.
19. Must be willing and able to work all business hours including evenings and weekends.
20. Perform all other duties as assigned.

QUALIFICATIONS:

To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION/EXPERIENCE:

1. High School Diploma or equivalency and three years of medical billing experience required.
2. Must demonstrate a clear understanding of medical terminology Current Procedural Terminology (CPT) and International Classification of Disease (ICD) coding.
3. Working knowledge of billing for a multi-discipline practice and general computer systems required.

LANGUAGE SKILLS:

Ability to read and interpret documents such as policies and procedures benefits information benefit surveys board minutes routine mail simple contracts and procedure manuals. Ability to compose routine reports and correspondence. Ability to speak effectively with employees visitors and management.

MATHEMATICAL SKILLS:

Ability to calculate figures and amounts such as discounts interest commissions proportions percentages and the ability to apply concepts of basic algebra and geometry.

REASONING ABILITY:

Ability to apply common sense understanding to carry out instructions furnished in written oral or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Ability to apply common sense to daily situations that arise. Ability to make decision and execute timely to produce a positive outcome.

OTHER SKILLS AND ABILITIES:

1. Demonstrates ability and flexibility to work in other areas of the organization as needed.
2. Adheres to companys policies and procedures.
3. Demonstrates required knowledge skills education for job functions.
4. Ability to organize and prioritize work with minimum supervision.
5. Ability to perform most essential job duties independently and exercise good judgment.
6. Must be flexible and detail oriented.
7. Demonstrate imitative and creativity in assigned work constantly attempting to improve workflows.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job the employee is regularly required to use hands to finger handle or feel and reach with hands and arms. The employee frequently is required to stand walk and sit. The employee is occasionally required to climb or balance stoop kneel crouch or sit. The employee must frequently lift and/or move up to 10 pounds and occasionally life and/or move up to 30 pounds. The employee is occasionally required to ascend and descend one flight of stairs. Specific vision abilities required by the job include close vision color vision and ability to adjust focus.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is often low. However there are many times when there is a high ambient background noise of phones and multiple conversations. Must be able to screen out the background noise to concentrate on the work at hand.