Patient Billing Rep

Job Overview

Title:

Patient Billing Rep I

Employer:

Nebraska Methodist Health System

Location:

Methodist Corporate Office, 825 S 169th St., Omaha, NE

Schedule:

Mon – Fri, 8‑hour shifts, flexible between 6:00 am and 6:00 pm

Core responsibility: billing, electronic claim submission, follow‑up, and collections of patient accounts.

• Electronic and Hardcopy Billing
  • Submit all EDI and paper claims as required by departmental and payer guidelines.
  • Obtain appropriate EOBs using health system resources.
  • Review Billing Scrubber Claim Detail Screens to ensure accurate data for submission.
  • Correct claim issues identified in the billing scrubber and document updates in the Source System.
  • Prepare secondary and tertiary billings, both manually and electronically, on UB‑04s and/or CMS‑1500s.
  • Submit adjusted UB‑04/837I and/or CMS
    1500/837P claims following departmental and payer guidelines.
• Display Effective Communication Skills
  • Demonstrate active listening skills.
  • Notify leaders and supervisors of identified issues.
  • Follow telephone etiquette procedures established by the organization.
  • Respond professionally and courteously to customers, health system staff, and management.
• Handling of Referrals
  • Timely and accurate handling of referrals, including escalated priorities, per departmental guidelines.
  • Document all referrals clearly and appropriately in the Source System.
  • Follow up with patients on the final results of inquiries and communicate outcomes professionally.
• Knowledge of System Applications
  • Maintain proficiency with current health system applications.
  • Identify, obtain, and print medical records as needed for denial resolution or system edits.
• Auditing of Patient Accounts
  • Apply accounting and business principles to determine remaining balances on encounters.
  • Update proration to allocate dollars to appropriate benefit orders accurately.
  • Use available resources to complete account audits.
  • Document audit findings and actions taken in the Source System.
• Claim Follow‑Up with Third‑Party Payers
  • Understand third‑party billing and follow‑up processes per department specifications.
  • Grasp contract‑related requirements.
  • Leverage payer websites and tools to expedite follow‑up.
  • Ensure appropriate documentation in the Source System.
  • Interpret correspondence accurately for handling.
• Special Projects and Tasks as Assigned
  • Complete assigned projects on time, accurately, and per leadership specifications.
  • Handle daily, weekly, and monthly assignments accurately and promptly.
• Maintaining Daily Workflow
  • Manage and maintain workflow queues according to departmental guidelines.
  • Process mail and correspondence per guidelines.
  • Document tasks in the Source System with proper methods.
  • Understand various work item, state‑based, and exception queues in the Patient Accounting System applications.

• High school diploma, General Educational Development (GED), or equivalent required.
• Coursework in Coding, Billing, or Healthcare Management, preferably through a secondary education institution or online classes via AHIMA.

• Minimum of one (1) year of experience in healthcare third‑party billing and/or claims processing preferred.
• Prior exposure to UP04 and/or CMS
  1500 claim data through work in a physician’s office or other healthcare setting preferred.

• N/A

• Interpret UB‑04 and/or CMS
  1500 claim data to troubleshoot claim edits and meet payer billing requirements accurately.
• Create and submit original and corrected claims.
• Audit accounts and payer explanations of benefits (EOBs) to determine appropriate actions.
• Use effective communication skills to handle patient inquiries, attorneys, health system staff, and payers professionally.
• Apply accounting and business principles for accurate auditing of patient accounts.
• Follow up with third‑party payers on claims and appeals to ensure timely and accurate processing.
• Maintain a working knowledge of multiple system applications.

• Light work:
  Exert up to 20 pounds of force.

• Occasionally performed (1%–33%):
  Balancing, climbing, carrying, crawling, crouching, distinguishing colors, kneeling, lifting, pulling/pushing, reaching, standing,…