Billing Account Representative
Healthcare Revenue Cycle Manager
A billing account representative will be crossed trained to perform a variety of duties within the billing office. Some of these duties will be accurately posting charges; timely preparation and submission of claims to third party payers, intermediaries, and responsible parties in accordance with billing policies and procedures; customer service such as taking phone calls or creating correspondence, understanding pre authorizations and service authorizations; posting payments to patient accounts; working aged reports; working denied claims; account reconciliations; processing refunds; processing collection accounts; placing collection calls.
Responsible for the accurate and timely submission of claims to third party payers, intermediaries, and responsible parties in accordance with billing policies and procedures.
Independent thinking and problem solving, including suggesting ideas to create improved efficiency and simplified processes.
Manually enters claims, analyzes and approves claims, identify and pending claims with problems, problem solving to resolve correct claims.
Prints, sorts, and mails manual claim forms when electronic billing is unavailable.
Responsible for error correction and rebilling of previously submitted claims that have been denied/suspended by third party payers.
Helps create and maintain positive working environment.
Keeps abreast of CPT, CDT, ICD-9, ICD-10, and HCPCS coding
Always respects the confidentiality of patient information when performing job duties.
Posts all payments and adjustments to patient accounts in a timely and accurate manner.
Consistently evaluates the accuracy of payments by third party payers.
Researches, reviews, and resolves any inconsistent payments (under or over the expected amount).
Investigates reasons for rejected/suspended claims. Corrects and resubmits claims which can be reprocessed for payment.
Follows up and makes notes on all outstanding accounts over 45 days post submission and contacts the payer to determine the claim's status, reworks claim appropriately.
Uses Explanation of Benefits (EOB) forms and payer reports to track and analyze claims denial data, and to post payments.
Prepares patient statements, refund documents, or collection documents as appropriate.
Answers billing office phone calls using proper customer service etiquette, and prepares correspondence as appropriate.
Is to be aware of and responsible for compliance with HIPAA guidelines.
Performs other duties as assigned.
Sedentary work – Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.
Stand or Sit (Stationary position)
Use hands/fingers to handle or feel (Operate, Activate, Use, Prepare, Inspect, Place, Detect, Position)
Stoop, kneel, crouch or crawl (Position self (to), Move)
Talk/hear (Communicate, Detect, Converse with, Discern, Convey, Express oneself, Exchange information)
See (Detect, Determine, Perceive, Identify, Recognize, Judge, Observe, Inspect, Estimate, Assess)
Pushing or Pulling
Category III – Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid
Equipment and Tools
(Complete with information required to perform essential functions of the job)
List Equipment used for job: computer, copier, fax, scanner, and other office equipment.
List Tools:Drives KIT or Personal Vehicle:Other:
Comments: Travel may be offered for training.
High school diploma or GED equivalent
Two years of medical billing experience preferred
Knowledge and experience working with Alaska Native/American Indian people preferred.
Knowledge of medical billing procedures and claims submission process
Knowledge and understanding of insurance processes
Knowledge of how to operate office equipment such as computer, calculator, printer, fax etc.
Knowledge of third party medical billing and reimbursement environment, including established procedures, forms, etc. associated with various health insurance programs.
Knowledge of basic medical and coding terminology.
Knowledge of basic customer service principles and HIPAA compliance issues
Ability to cooperate with other staff members both within and outside department.
Always exhibits traits of courtesy, caring, helpfulness, and respect.
Conducts self in a service-oriented manner that is attentive, pleasant, respectful and kind when dealing with customers, visitors, public, employees, and others.
Ability to be a team player.
Excellent analytical thinking skills, ability to be organized, and detail oriented.
Displays a high degree of professionalism.
This Job Description reflects Kenaitze Indian Tribe's best effort to describe the essential functions and qualifications of the job described. It is not an exhaustive statement of all the duties, responsibilities or qualifications of the job. This document is not intended to exclude an opportunity for modifications consistent with providing reasonable accommodation. This is not intended to be a contract.