Patient Billing/Follow-up Rep

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 I

Bills all non-EDI Primary Health Plans both UB04 & 1500.

• All claims billed on a daily basis are to be submitted same day unless there is a system problem.
• Submits claims according to payer specific guidelines.
• Ensures claims are submitted to appropriate Payer physical address.

Bills all health plans electronically both UB04s and/or 1500s in an accurate and timely manner for appropriate reimbursement.

• All claims are to be billed daily with exception of claims Pended on Hold or if system problems. Exception claims must be fully documented.
• Submits claims according to payer specific guidelines.

Prepares secondary and tertiary billings manually and electronically on UB04s and 1500s for accurate reimbursement.

• Obtains appropriate EOBs through use of Resources - Intenal/External Electronic systems listed: MREP Application Xtender Revenue Manager PC Print QMS and/or Individual Payer Websites.
• Claims billed in the time frame set by Department
• Submits claims according to Payer specific guidelines.

Reviews Claims and determines appropriate action to be taken by understanding and navigating the Electronic Billing Software.

• Daily prioritize sort and maintain claims based on status for timely handling. ie: Rejects/Invalids/Pends/Denied and Holds.
• Identifies and works electronic claim edits from a payer perspective.
• Reviews Revenue Manager Claim Detail Screens to ensure data is appropriate for claim submission.
• Ensure that claim corrections identified in Rev Manager are appropriately updated in Source System.

Review and Follow Up of accounts to ensure appropriate 3rd Party Payer reimbursement is received through to closure of Account.

• Prioritize maintain 11 Workflow Queues on daily basis.
• Appropriate use of resources: Internet Record Link Powerchart Telephone All Payer Websites FISS Email to obtain information to resolve patient accounts.
• Ensure Daily/Weekly/Monthly Reports are accurately and timely.
• Perform audits on all accounts to verify balance is accounted for and appropriate action is taken.

Processes all daily Mail and Referrals received in an accurate and timely manner.

• Mail/Correspondence to be processed following department guidelines of 5 days from receipt.
• Referrals to be processed following department guidelines of 5 days from initial receipt.

Documents in the appropriate records system any action taken in handling accounts.

• Appropriate documentation in Source system when necessary
• Complete and accurate documentation must be added immediately following action taken on accounts
• Who what where when documentation method ID used in documentation process.
• Uses proper abbreviations and demonstrates professionalism and consistency in documentation.

Patient complaints are handled in a timely and appropriate fashion.

• Works patient complaints as a high priority within 24 hours.
• Notifies patient of final results of account handling in question in a timely manner.
• Documentation of all patient calls.
• Professional courtesy expected when working directly with patient.

Consistent handling of Telephone calls.

• Professional/Courteous responses when communicating with customers both internal & external.
• Timely follow up with responses.
• Proper use of Telephone by following department guidelines on personal use of business telephone.

Schedule:

Mon - Fri 8:00am to 4:30pm

Job Description:

Job Requirements

Education

• High school diploma General Educational Development (GED) or equivalent required

Experience

• 1-2 years of experience in health care third party billing and/or claims processing preferred.

License/Certifications

• N/A

Skills/Knowledge/Abilities

• Requires basic navigation skills in Microsoft Office applications including Outlook Excel Powerpoint and Word.
• Preferred knowledge of ICD-9 ICD-10 CPT-4 and HCPCS coding.
• Requires the ability to learn how to prepare and process third-party billing to include the ability to read an explanation of benefit and account auditing experience.
• Requires the ability to navigate obtain information online.
• Requires the ability to learn & maintain working knowledge of the following systems: Cerner Patient Accounting Revenue Manager Medicare Online System (FISS) MREP PC Print and/or all Payers Websites.
• Requires analytical ability to review accounts to determine appropriate action.
• Requires effective communication skills for handling patients attorneys; inter departmental staff and Insurance Companies at a professional level.
• Requires the ability to understand basic accounting and business principals to enable accurate auditing of patient accounts execution of claims scrubbers and ability to read EOBs.

Physical Requirements

Weight Demands

• Light Work - Exerting up to 20 pounds of force.

Physical Activity

• Occasionally Performed (1%-33%):
  • Balancing
  • Climbing
  • Carrying
  • Crawling
  • Crouching
  • Distinguish colors
  • Kneeling
  • Lifting
  • Pulling/Pushing
  • Reaching
  • Standing
  • Stooping/bending
  • Twisting
  • Walking
• Frequently Performed (34%-66%):
  • Hearing
  • Repetitive Motions
  • Seeing/Visual
  • Speaking/talking
• Constantly Performed (67%-100%):
  • 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 X-ray Cat Scan Gamma Knife etc)
  • Radiation Non-Ionizing (Ultraviolet visible light infrared and microwaves that causes injuries to tissue or thermal or photochemical means)
• Rare (1-33%):
  • 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.