Patient Billing Rep II

Overview

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. It’s helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient’s 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.

Location & Schedule Location:
Methodist Corporate Office. Address: 825 S 169th St.

- Omaha, NE.

Work Schedule:

Mon - Fri, business hours.

Responsible for billing, electronic claims submission, follow up and collections of patient accounts.

Essential Functions

• UB04/837I and CMS
  1500/837P 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 EOB's 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 UB04's and/or 1500's for accurate reimbursement.
• Submits adjusted UB04/837I and/or CMS
  1500/837P claims according to department and payer specific guidelines.

• Display Effective Communication Skills
• Demonstrates active listening skills.
• Notifies and keeps supervisor informed on denial and any other trends identified.
• 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…