Medical Billing Representative

LOCATION: Seacomm Plaza, Potsdam

DEPARTMENT: Medical Billing

SCHEDULE: Days; 8am - 4pm

ATTRIBUTES

• Preferred: Bachelor's degree in related field

• Preferred: 3 years healthcare billing experience

• Preferred: AHIMA/AAPC Certified

RESPONSIBILITIES

• Using hospital computer system, ascertains status of patients' accounts. Reviews account information to determine completeness of data; e.g. final diagnosis, etc.

• Prepares and submits in a timely manner claims. Submission is made in compliance with DRG regulations and/or contractual terms.

• Processes follow-up billing as required.

• Utilizes payer on-line sites an/or teleprocessing units to verify eligibility, benefits, and pre-certification requirements. Documents accounts with this information and communicates information to Patient Family Services department as necessary.

• Prepares daily loss and gain records for third party accounts, and transactions for DRG adjustments, DRG discounts, or contractual adjustments.

• Accurately works payer remittances.

• Receives calls regarding status of patient accounts; answers routine questions for patients and appropriate others, such as method of payment, explanation of benefits and charges, etc. Refers unusual questions or situations to supervisor.

• Submits adjustments to reflect correct charges and reimbursable amounts.

• Contacts patient, responsible party or carriers to obtain missing information, signatures, release forms, etc. or to provide appropriate forms, e.g. to complete billing cycle. Updates system with this information.

• Completes data processing source document with required information and submits to appropriate insurance carrier.

• May type letters, reports, lists; files posts, and sorts.