Billing and Follow-Up Representative II – Hospital Medical Billing Follow-up, Medicaid/HMO

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.
• 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, 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.
• 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.
• Other duties as needed and assigned by the supervisor.
• Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

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.
• Experience in a complex, multi-site environment preferred.
• Proficiency in Microsoft Office, including Outlook, Word, PowerPoint, and Excel.
• Experience and knowledge of hospital medical billing follow-up with Medicaid/HMO highly desirable.
• 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.