Patient Billing Rep II
Company: Methodist Health System
Posted on: March 19, 2023
Why work for Nebraska Methodist Health System?
At Nebraska Methodist Health System, we focus on providing
exceptional care to the communities we serve and people we employ.
We call it The Meaning of Care - a culture that has and will
continue to set us apart. It's helping families grow by making each
delivery special, conveying a difficult diagnosis with a
compassionate touch, going above and beyond for a patient's needs,
or giving a high five when a patient beats a disease or conquers a
personal health challenge. We offer competitive pay, excellent
benefits and a great work environment where all employees are
valued! Most importantly, our employees are part of a team that
makes a real difference in the communities we live and work in.
Responsible for billing, electronic claims submission, follow up
and collections of patient accounts.
UB04/837I and CMS1500/837P Claim Edit
- All EDI and paper claims submitted are to be billed as needed
following department and payer specific guidelines.
- Obtains appropriate EOB's through use of health system
- Reviews Billing Scrubber Claim Detail Screens to ensure data is
appropriate for claim submission.
- Ensure that claim corrections identified in billing scrubber
are appropriately updated and documented in Source System.
- Prepares secondary and tertiary billings, manually and
electronically on UB04's and/or 1500's for accurate
- Submits adjusted UB04/837I and/or CMS1500/837P claims according
to department and payer specific guidelines. Display Effective
- Demonstrates active listening skills.
- Notifies and keeps supervisor informed on denial and any other
- Follows telephone etiquette procedures set forth by the
organization and/or individual department.
- Professional/Courteous responses when communicating with
customers, health system staff and management.
- Can effectively communicate in meetings/forums to a large or
medium group of individuals.
- Works with supervisor to streamline process and decrease
inefficiencies. Handling of Referrals
- Timely and accurately handling of referrals, both regular and
escalated priority from management, within department
- Documents clearly and appropriately all referrals (including
patient inquiries) in the Source System when necessary.
- If necessary, follows up with patients on final results of
inquiry both timely and professionally. Notifies patient of final
results of account handling in question. Knowledge of System
- Demonstrates ability to learn and maintain a working knowledge
on all the current health system applications.
- Identify/obtain/print medical records as necessary for
resolution of denial or system edits according to department
- Assists with testing and roll out plans to introduce new
functionality within system applications used by the department.
Auditing of Patient Accounts
- Understand accounting and business principles to accurately
determine the remaining balance on a given encounter.
- Upon accurately auditing encounter or visit, is able to
understand and update proration to make sure dollars are allocated
to the appropriate benefit orders if needed.
- Leverages all needed resources to complete an audit of an
- Documents audit finding and actions taken in Source System when
necessary. Claim/Appeal Follow Up with Third Party Payers
- Full understanding of all necessary third party payer appeals,
billing and follow up guidelines including specific time frames and
possible form filing requirements.
- Leverages payer websites, automated tools and contract
resources to streamline the follow up process.
- Appropriate documentation in Source System when necessary.
- Ability to interpret all appeal and follow up correspondence
for accurate handling. Denial Trending and Analysis
- Can clearly identify, trend and articulate patterns and issues
from provided denials data.
- Can clearly provide alternative solutions with regards to
- Leverage all necessary denial data sources as needed for
trending and analysis.
- Leverage all necessary contract manager data sources and payer
contracts as needed for reimbursement analysis.
- Has the ability to effectively network and communicate with
outside department, payers, patients and any other necessary
resources to resolve denial issues timely. Transaction
- Able to identify and correct transaction codes for proper write
- Accurate usage of transaction codes for efficient
- Posts transactions within the departmental thresholds. Special
Projects and Tasks as Assigned
- Completion of any assigned projects timely, accurately and to
the specifications of leadership.
- Ability to articulate and communicate trend or other findings
to various leadership personnel within the organization.
- Ensure Daily/Weekly/Monthly assignments are handled accurately
and timely. Maintaining Daily Workflow
- Manages and maintains assigned workflow queues according to
- Follow appropriate policies and procedures with regards to
handling of denials and all other assigned queues.
- Mail/Correspondence processed and handled following
- Documents both timely and appropriately in Source System using
proper documentation methods.
- Fundamental understanding of different work item, state based
and exception queues within the Patient Accounting System
8:00 am - 4:30 pm
- High school diploma, General Educational Development (GED) or
- Coursework in Coding, Billing or Healthcare Management normally
acquired through enrollment in a secondary education institution or
online classes through the American Heath Information Management
Association (AHIMA) preferred.
- Demonstration of knowledge and practice in medical terminology,
third party payer appeals, denial trending and analysis, ICD-9,
ICD-10, CPT4/HCPCS Coding, UB04 and CMS1500 claim data as supported
by the Patient Billing Rep Skill Set Examination
- Minimum of 1-2 years experience in a healthcare business office
setting operating patient accounting software, electronic billing
software and/or accessing payer websites required.
- Prior experience interpreting contractual language
- Ability to create and submit both original and corrected
- Skill in interpreting UB04 and/or CMS1500 claim data to be able
to troubleshoot claim edits and resolve payer billing requirements
both timely and accurately.
- Ability to audit accounts and payer explanation of benefits
(EOBs) to determine appropriate action.
- Ability to maintain a working knowledge of multiple system
- Ability to use effective communication skills in order to
handle patient inquires, attorneys, health system staff and payers
on a professional level.
- Knowledge and understanding of accounting and business
principles to enable accurate auditing of patient accounts.
- Ability to follow up with the 3rd party payers for claims and
appeals submitted to ensure timely and accurate processing.
- Ability to review and clearly articulate denial trends and
patterns to identify potential opportunity to prevent denials and
maximize reimbursement. Physical Requirements
- Light Work - Exerting up to 20 pounds of force.Physical
- Occasionally Performed (1%-33%):
- Distinguish colors
- Frequently Performed (34%-66%):
- Repetitive Motions
- Constantly Performed (67%-100%):
- SittingJob Hazards
- Not Related:
- Biological agents (primary air born and blood born viruses)
(Jobs with Patient contact) (BBF)
- Physical hazards (noise, temperature, lighting, wet floors,
outdoors, sharps) (more than ordinary office environment)
- Explosives (pressurized gas)
- Electrical Shock/Static
- Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat
Scan, Gamma Knife, etc)
- Radiation Non-Ionizing (Ultraviolet, visible light, infrared
and microwaves that causes injuries to tissue or thermal or
- Rare (1-33%):
- Chemical agents (Toxic, Corrosive, Flammable, Latex)
- Mechanical moving parts/vibrations About Methodist:
Nebraska Methodist Health System is made up of four hospitals in
Nebraska and southwest Iowa, more than 30 clinic locations, a
nursing and allied health college, and a medical supply
distributorship and central laundry facility . click apply for full
Keywords: Methodist Health System, Omaha , Patient Billing Rep II, Accounting, Auditing , Omaha, Nebraska
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