Hours: Mon – Fri, 40 hours/week
MEDICARE BILLER & FOLLOW-UP REPRESENTATIVE
Additional notes from Manager:
Must have inpatient and outpatient hospital billing
· The Medicare Biller and Follow-up Representative is responsible for the management of patient accounts from the point of admission to reimbursement from the payor.
· Works directly with patients, internal departments, external business partners (IPA’s, provider relations, government payors and insurance companies) and clinical departments for delivery of service to include but not limited to:
· Obtains the maximum reimbursement for hospital services, effectively maintains a professional and ethical relationship with all clients, payors and staff.
· Has expert knowledge of payor contracts, CPT/HCPCS and ICD-10 codes, medical policies, LCD’s and medical terminology.
· Works efficiently to ensure accounts are worked thoroughly and within a timely manner.
· Thrives within a team atmosphere, has strong customer service expertise, has a strong ability to multitask and has proficient computer skills.
JOB SPECIFIC ESSENTIAL FUNCTIONS:
· Serve as the account representative for Hoag in working with insurance companies and/or government payors for resolution of payments.
· Completes daily assigned accounts on the collection work-list.
· Obtains the maximum amount of reimbursement by evaluating claims at the contract rate with the use of the contract management tool for proper pricing (Examples: APC, DRG, APRDRG).
· Reviews and initiates the initial appeal for underpayments observing all timely requirements to secure reimbursement due to Hoag.
· Conducts an audit of accounts for billing and regulatory requirements.
· Help identifies charge capture and missing charge.
· Recommends denial edits to help mitigate denials issues.
· Reviews and completes payor correspondence in a timely manner.
· Escalates to the payor accounts that need to be appealed due to improper billing, coding and/or underpayments. • Reports new/unknown billing edits to direct supervisor for review and resolution.
· Has a strong understanding of the Revenue Cycle processes, from Patient Access (authorizations & admissions) through Patient Financial Services (billing & collections), including procedures and policies.
· Has thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements.
· Interprets Explanation of Benefits (EOBs) and Electronic Admittance Advices (ERAs) to insure proper payment as well as assist and educate patients and colleagues with understanding of benefit plans.
· Understanding of hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.
· Knowledge of HMO, POS, PPO, EPO, IPA, Medicare Advantage, Covered California (Exchange), capitation, commercial and government payors (i.e. Medicare, Medi-cal)and how these payors process claims.
· Demonstrates knowledge of and effectively uses patient accounting systems.
· Performs other duties as assigned.
EDUCATION, TRAINING AND EXPERIENCE REQUIRED:
· High school diploma or equivalent with 2-3 years of hospital billing and/or collection experience
Skills or Other Qualifications:
· Analytical, critical thinking and sound decision making skills
· Basic skills in Microsoft Office (Word/Excel). Ability to communicate in a clear and professional manner
· Strong interpersonal skills
· Ability to problem solve, prioritize and follow-through completely with assigned tasks
Ajinkya (AJ) Karyakarte