Billing Services Representative

Ensure account accuracy. Review daily claims to ensure submissions are clean and timely. Monitor charges/modifiers/CPT-4s/HCPCS/payments/DRGs/ICD-10 coding.

Review outstanding accounts using ATB/queues/payments reports/halt report/electronic billing edits/credit balances. Submit timely and accurate adjustments/notes/patient balance transfers and medical record requests. Work with management team and notifying of notifying of issues that arise with payors/departments/etc Resolve account issues and problem solving independently whenever possible.

Use technology provided (including hospital information system, contract management system, electronic billing system, payer websites and document imaging system. Manage denials and appealing administrative claims. Understand denials and how they should be handled.

Send clinical denials and downgraded claims to appropriate parties to ensure timely appeal. Ensure claims denied at time of billing are distributed to appropriate parties for review. Update and correct accounts with assistance of originating departments (charges/authorizations/insurance issues).

Follow departmental and hospital policy and procedure (this includes HIPAA guidelines and Federal guidelines). Understand payor contracts and billing guidelines; revenue codes and payor specific requirements; and payor/plan codes. knowledge of Medicare and Medicaid