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Patient Billing Rep I

Company: Methodist Health System
Location: Omaha
Posted on: January 16, 2022

Job Description:

  • Purpose of Job
    • Responsible for billing, electronic claims submission, follow up and collections of patient accounts.
    • Job Requirements
      • Education
        • High school diploma, General Educational Development (GED) or equivalent required
        • 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.
        • Experience
          • Minimum of one (1) year prior experience in healthcare third party billing and/or claims processing preferred.
          • Prior exposure to UP04 and/or CMS1500 claim data normally acquired through work in a physician's office or other healthcare setting preferred.
          • License/Certifications
            • N/A
            • Skills/Knowledge/Abilities
              • 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 create and submit both original and corrected claims.
              • Ability to audit accounts and payer explanation of benefits (EOBs) to determine appropriate action.
              • 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 maintain a working knowledge of multiple system applications.
              • Physical Requirements
                • Weight Demands
                  • Light Work - Exerting up to 20 pounds of force.
                  • Physical Activity
                    • Occasionally Performed (1%-33%):
                      • Balancing
                      • Climbing
                      • Carrying
                      • Crawling
                      • Crouching
                      • Distinguish colors
                      • Kneeling
                      • Lifting
                      • Pulling/Pushing
                      • Reaching
                      • Standing
                      • Stooping/bending
                      • Twisting
                      • Walking
                      • Frequently Performed (34%-66%):
                        • Hearing
                        • Repetitive Motions
                        • Seeing/Visual
                        • Speaking/talking
                        • Constantly Performed (67%-100%):
                          • Fingering/Touching
                          • Grasping
                          • Keyboarding/typing
                          • Sitting
                          • Job 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)
                              • Equipment/Machinery/Tools
                              • 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 photochemical means)
                              • Rare (1-33%):
                                • Chemical agents (Toxic, Corrosive, Flammable, Latex)
                                • Mechanical moving parts/vibrations
                                • Note: Safety Officer can assist with identification of job hazards
                                • Essential Job Functions
                                  • Essential Functions I
                                    • Electronic and Hardcopy Billing
                                      • 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 resources.
                                      • 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 reimbursement.
                                      • Submits adjusted UB04/837I and/or CMS1500/837P claims according to department and payer specific guidelines.
                                      • Display Effective Communication Skills
                                        • Demonstrates active listening skills.
                                        • Notifies and keeps leads and supervisors informed on issues identified.
                                        • 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.
                                        • Handling of Referrals
                                          • Timely and accurately handling of referrals, both regular and escalated priority from management, within department guidelines.
                                          • 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 Applications
                                            • 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 guidelines.
                                            • 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 account.
                                              • Documents audit finding and actions taken in Source System when necessary.
                                              • Claim Follow Up with Third Party Payers
                                                • Full understanding of all necessary third party billing and follow up processes based on department specifications.
                                                • Full understanding of all necessary contract related requirements.
                                                • Leverages payer websites and necessary tools to streamline the follow up process.
                                                • Appropriate documentation in Source System when necessary.
                                                • Ability to interpret correspondence assigned for accurate handling.
                                                • Special Projects and Tasks as Assigned
                                                  • Completion of any assigned projects timely, accurately and to the specifications of leadership.
                                                  • Ensure Daily/Weekly/Monthly assignments are handled accurately and timely.
                                                  • Maintaining Daily Workflow
                                                    • Manages and maintains assigned workflow queues according to department guidelines.
                                                    • Mail/Correspondence processed and handled following departmental guidelines.
                                                    • 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 applications.
                                                    • Essential Functions II
                                                      • Participates in mandatory in-services and/or CE programs as mandated by policies and procedures/external agencies and as directed by management.
                                                      • Follows and understands the mission, vision, core values, Employee Standards of Behavior and company policies/procedures.
                                                      • Other duties as assigned.

Keywords: Methodist Health System, Omaha , Patient Billing Rep I, Other , Omaha, Nebraska

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