A/R Representative - Customer Service Billing

Grady Health System is hiring an A/R Representative to review and resolve hospital claims under the supervision of the Patient Financial Services Supervisor. The role supports timely billing, payment posting and reconciliation, insurance follow-up, and resolution of account issues.

Responsibilities:

• Monitor work queue (WQ)s containing claim errors, Discharged not Billed (DNB)s and rejections and perform timely submission
• Possess a good understanding of different types of medical insurance carriers and their claim requirements. Recognize the areas of revenue cycle and their role in accurate claim information and work with these departments to resolve bill/claim edits
• Understand Explanation of Benefit (EOB)/Remits
• Respond to Vendor requests in a timely and professional manner
• Perform necessary maintenance to accounts in the billing system
• Perform timely follow-up with third-party insurance carrier (Government and Non-Government entities) on unpaid, underpaid, and denied facility accounts/claims
• Take appropriate action to resolve problems causing delay in reimbursement
• Timely review, documentation and appropriate action on incoming Payer and Patient correspondence
• Identify and report Payer denial, or underpayment trends to Supervisor and or Management
• Verify account insurance liability (bucket) and patient liability (bucket) is correct
• Post, balance, and reconcile patient account payments for Accounts Receivable
• Accept and process assigned batches electronically within the Hospital billing module; correcting remittance errors generated after processing
• Monitor and correct errors routed to work queues; responsible for correcting errors and clearing work queues regularly
• Post self-pay remittance files to respective guarantor accounts in the system. Manually post EOB files and paper checks received from the lockbox. Post denial information and other pertinent follow-up information. Close each batch by verifying all payments have been posted appropriately and reconciled to the cash control amount specified
• Responsible for posting insurance recoupments using designated debit or credit payment codes
• Monitor A/R Aging by payer to ensure billing has been submitted timely for primary and secondary payers
• Collect Private pay balances to ensure statements are processed and paid promptly
• Ability to review Division of Family and Children Services (DFCS) notices vs Gammis to ensure correct patient liability is calculated for each account (in an attempt to not have unnecessary credit balances)
• Respond to Vendor requests in a timely and professional manner
• Perform necessary maintenance to accounts in the billing system
• Utilize appropriate in-house adjustment codes and activity codes; Meet productivity and quality standards as described in the department policy and procedures
• Attend and/or complete all required department training
• Assist where necessary with end of month reconciliation procedures
• Prepare supporting documentation for Leadership
• Other duties as assigned

Requirements:

• Must be able to accurately type 30 WPM and successfully complete competency exam with 80% proficiency
• Must possess business knowledge and results oriented experience within Patient Financial Service and demonstrated knowledge and experience with the Microsoft Suite skill set to include Excel and Word
• Must be highly motivated and detail oriented with excellent teaming skills and possess excellent communication, time management, and organizational skills
• Must possess the ability to be flexible, work collaboratively among internal and external departments, and effectively investigate, analyze, and solve problems
• Hands on knowledge of Current Procedural Terminology (CPT), International Classification of Diseases (ICD-9) coding, Healthcare Common Procedure Coding System (HCPCS), revenue codes and hospital billing terminology
• Knowledge of Outpatient Code Editor (OCE) and Correct Coding Initiative (CCI) edits
• Job related experience in health care revenue cycle
• Demonstrated service and success in teamwork and consistent high productivity and quality
• Working knowledge of Medicare Secondary payer as well as medical necessity requirements
• Epic experience
• Hands on Knowledge of Medicare and Medicaid regulations, experience with Uniform billing – UB-04 and healthcare finance administration (HCFA), 1500 claims forms billings and follow up functions both electronic and manual
• 2 years of college (Associate Degree)
• Billing background (Hospital and physician billing)