Follow Up and Billing Rep

Job Description
Demonstrate respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background. This position is responsible for the accurate and timely billing and collection of assigned accounts using computerized patient accounting systems. This position must stay current with workers compensation billing rules, OSHA regulations, workers compensation regulations, and contractual agreements with payers. This position is also responsible and accountable for communication to the leadership team regarding identified issues with charges, orders, invoicing etc. This position is also responsible to work with, train and orient physicians/providers with accurate and appropriate coding of work compensation charges.

Job Duties

Communication/Trending:

• Trends weekly productivity, Billing WIP, Follow-up WIP and agings.
• Attends weekly billing staff meetings
• Identifies payor & billing issues
• Participates in a positive & constructive manner
• Addresses and follows up on any client call or concern by next business day.

Billing Responsibilities:

• Reviews bills and related information for accuracy and reasonableness of charges
• Submits bills to payers electronically if possible, otherwise paper
• Submits monthly self-pay statements to clients
• Stays current with third party contractual agreements and regulations to apply requirements for accurate billing and to make recommendations for system changes as needed
• Maintains zero billing WIP

Follow-Up Responsibilities:

• Calls payers for status on accounts on work list
• Records appropriately detailed notes in the Systoc system
• Takes appropriate action to resolve claims, i.e., the rep would proceed to complete any and all steps to have the claim paid. Including and not limited to; re-file claim, send notes, make corrections to the claim information, call employer, call patient, etc.
• Writes appeal letters
• Communicates with supervisor at Business Health and at payers
• Calculates expected reimbursement on accounts if necessary
• Holds payers responsible to contract terms and fee schedules
• Completes work list with the activity code, tickle date, phone number
• Demonstrates ability to work with high volume of outgoing calls associated with collection of accounts
• Demonstrates adequate, appropriate, and professional levels of communication with insurance company representatives, team members, supervisors, and managers.
• Establishes relationship with payer contacts
• Ensures timely turnaround of internal requests (EOB’s, medical records) through effective follow-up
• Performs due diligence on all collection efforts
• Ensures expected reimbursement is secured
• Elevates serious barriers to claim resolution to appropriate management
• Assists other follow-up reps when necessary, as determined by manager, work with billing staff to identify and resolve billing issues and develop standard billing practices
• Maintains zero follow-up WIP

Performs other duties as assigned.
Qualifications

Education, Credentials, Licenses:
High school diploma or equivalent

Specialized Knowledge:
Medical billing experience as acquired in a physician office setting.
PC Skills, including Word and Excel.
Customer Service Skills
Excellent Communication Skills

Knowledge of workers compensation and
third-party billing rules and regulations

Kind and Length of Experience:
One-year experience in
physician billing and collections or equivalent education