Billing & 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 provides 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, including 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
• Researches claim rejections, makes corrections, takes corrective actions, and/or refers claims to appropriate colleagues to ensure timely and accurate claim resolution
• Proactively follows 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
• Assists in the training and education of Billing and Follow-up Representative I colleagues

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
• Proficiency in Microsoft Office, including Outlook, Word, PowerPoint, and Excel
• 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
• Must be comfortable operating in a collaborative, shared leadership environment