Billing and Follow-up Representative II – Hospital Medical Billing Follow-up – Commercial Payors

Role Overview

• Performs the day-to-day billing and follow-up activities within the revenue operations for an assigned Patient Business Services (PBS) location
• Serves as a member of the billing and follow-up team assigned to a PBS location responsible for billing and follow-up of government and non-government accounts
• Provides training and guidance to lower level colleagues and provide problem resolution as needed
• Documents claims billed, paid, settled, and follow-up in appropriate system(s)
• Identifies and escalates issues affecting accurate billing and follow-up activities
• Adheres to proactive practices which includes contacting the payer directly for payment due on accounts and reviewing and responding to all mail correspondence in a timely and accurate manner
• Communicates with appropriate hospital departments to clarify billing discrepancies, and obtain demographic, clinical, financial, and insurance information
• Performs all follow-up functions which includes the investigation of overpayments, underpayments, credit balances and payment delays
• Tasks will be routed to the correct workflows with the objective of maximizing reimbursement for services rendered and ensuring claims are paid or settled in a timely and accurate manner
• Researches claim rejections, make corrections, take corrective actions, and/or refer claims to appropriate colleagues to ensure timely and accurate claim resolution
• Proactively follow up on delayed payments by contacting patients and third-party payers and determining the cause for delay and supplying additional data as required
• May prepare special reports as directed by the Supervisor Billing and Follow-Up to document follow-up services, e.g., number of claims and dollars billed, claims edited, claims unprocessed, etc.
• Assists in the training and education of Billing and Follow-up Representative I colleagues upon hire and ongoing, and as new systems, processes or payers are created
• Provides problem resolution to billing and follow-up issues as needed

Requirements

• High school diploma or Associate's degree in Accounting or Business Administration or related field
• Minimum of three (3) or more years' of direct experience and relevant knowledge of revenue cycle functions and systems working within a hospital or clinic environment, a health insurance company, managed care organization or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting or customer service activities or an equivalent combination of education and experience
• Proficiency in Microsoft Office, including Outlook, Word, PowerPoint, and Excel
• Completion of regulatory/mandatory certifications and skills validation competencies preferred
• Excellent verbal and written communication and organizational abilities
• Strong interpersonal skills are necessary in dealing with internal and external customers
• Accuracy, attention to detail and time management skills
• Ability to work independently
• Ability perform billing and follow-up activities in a prompt and accurate manner in order to reduce potential financial loss to the patient and the Ministry Organization
• Must be comfortable operating in a collaborative, shared leadership environment
• Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.