Collections Representative Government Billing

Position Summary:

The Collections Representative Government Billing is responsible for the accurate and timely billing of inpatient outpatient and laboratory claims to government and third-party payers. This role ensures compliance with payer regulations billing guidelines and timely filing requirements while maintaining account accuracy and maximizing reimbursement.

Minimum Qualifications:

High school diploma or equivalent required.

2-5 years of experience in Medicare Billing and collection for inpatient and outpatient

Proficiency with standard office equipment and computer applications.

Key Responsibilities:

Claims Billing & Processing

Review and analyze accounts to determine appropriate billing procedures based on payer type financial class and claim requirements.

Prepare review and submit electronic and paper claims in accordance with federal state payer and organizational guidelines.

Verify claim accuracy including demographics charges authorizations coding and supporting documentation.

Research and obtain missing information from internal departments and external sources as needed.

Monitor and resolve claim edits rejections denials and billing exceptions.

Submit required supporting documentation including authorizations medical records consent forms and payer-specific forms.

Ensure compliance with timely filing requirements and payer regulations.

Identify and bill capitated services to the appropriate responsible party.

Maintain claim management systems and resolve claim scrubber edits and billing holds.

Account Maintenance & Adjustments

Process account corrections adjustments transfers rebills and write-offs according to departmental procedures.

Update payer case and account information accurately and document all actions taken.

Submit adjustment requests requiring management approval when applicable.

Maintain accurate account notes and billing documentation within patient accounting systems.

Documentation & Compliance

Document billing activity claim details expected reimbursement payments and account actions clearly and accurately.

Protect patient confidentiality and comply with HIPAA and organizational privacy standards.

Adhere to all regulatory requirements hospital policies and billing compliance guidelines.

Quality & Performance

Maintain established productivity and quality standards.

Monitor accounts to ensure timely claim submission and follow-up.

Communicate billing issues trends and operational concerns to leadership.

Participate in performance improvement initiatives and process enhancement efforts.

Support special projects and departmental objectives as assigned.

Customer Service

Provide professional and courteous service to patients payers and internal stakeholders.

Demonstrate effective communication and problem-solving skills.

Foster positive working relationships across departments and with external partners.

Required Knowledge & Skills:

Knowledge of hospital billing practices government payer regulations and managed care contracts.

Experience with electronic claims processing and patient accounting systems.

Proficiency in Microsoft Office applications including Word and Excel.

Strong analytical organizational and problem-solving skills.

Ability to manage multiple priorities and meet productivity and quality expectations.

Knowledge of healthcare billing software and payer portals preferred.