Billing Patient Account Rep

Job Description

PURPOSE AND SCOPE:

Under the direct supervision of the Billing & Quality Supervisor, responsible for identifying errors with claim data in the electronic billing work list, researching accounts, and proactively following up with appropriate contacts to ensure necessary information is obtained in order to resolve issues for timely transmission of claims.  Generates various billing-related month-end reports and reviews any issues with management as necessary.

Supports FMCNA’s mission, vision, core values and customer service philosophy.  Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements.

DUTIES / ACTIVITIES:

CUSTOMER SERVICE:

Responsible for driving the FMS culture though values and customer service standards.
Accountable for outstanding customer service to all external and internal customers.
Develops and maintains effective relationships through effective and timely communication.
Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.

PRINCIPAL RESPONSIBILITIES AND DUTIES

Reviews and researches accounts to identify errors with claims, takes the required actions including following up with the pertinent personnel to obtain the required information to address and resolve the identified issues.
Reviews edits to claims through the electronic billing work list to ensure that all errors are identified and resolved in a timely manner so that claims are created and sent to the payers without delay.

-  Utilizes the external clearinghouse (Zirmed) or Medicare/Medicaid Direct payer Data Entry (DDE) systems to find any claims that have been rejected due to claim data errors. 

-  Once rejected claims have been identified, makes required claim data corrections in the internal billing system (eCube Financials).

-  Ensures corrected claims are created and sent to the payer in a timely fashion.

-  Generates claims report to verify claims sent electronically the previous day have been received by Zirmed or Medicare/Medicaid payer DDE systems. 

-  Troubleshoots and  resolves claims that have not been received successfully.

-  Ensures that secondary claims, along with required documentation, are mailed in a timely fashion.

On the first business day of each month, generates the Treatment & EPO Balancing and Revenue Posting Reports to ensure that treatment and EPO services are reconciled between eCube Financials and the Clinical system.
Generates billing related month end reports and review any issues with Supervisor / Manager as deemed necessary.  Reports include:

-  The Unbilled Insurance Totals Report to identify any claims that remain unbilled at the close of a billing period.

-  The Billed Insurance Cube Report to generate the billed insurance totals for the month.

-  The Billed Guarantor Report to generate billed guarantor amounts for the month.

Other duties as assigned.

Job Requirements

PHYSICAL DEMANDS AND WORKING CONDITIONS:

The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

Able to lift up to 50 lbs. independently with some manipulation of supply and inventory expected.  Requires sitting and standing for extended periods of time.  Requires adequate visual acuity, manual dexterity and hearing (with or without accommodation).  Work environment includes inside work primarily around office equipment. 

 

EDUCATION:

High School Diploma or equivalent.

EXPERIENCE AND REQUIRED SKILLS:

1-2 years healthcare billing or collections experience required with a High School Diploma.
No experience required with a Healthcare Certificate or 2 or 4 year Degree
Specific knowledge and experience with Medicare and Medicaid preferred
Working knowledge of Windows-based software applications (i.e.; Word, Excel).
Ability to analyze data.
Excellent written and verbal communication skills.
Good interpersonal skills and team oriented.
Well organized and detail oriented.
Positive attitude, enthusiastic and energetic.

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