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Professional Billing Claims Follow Up Rep II
Cincinnati Children's Hospital Medical Center
Details
Posted: 14-Mar-23
Location: Cincinnati, Ohio
Salary: Open
Categories:
Allied Health
Internal Number: 131544
As a Professional Billing Claims Follow Up Representative you will be responsible for reviewing claims edits and denials, making claim corrections, and ensuring accurate billing to commercial and government payors. In addition, following claims once submitted to the payors; Investigating and resolving denials, follow up with payors, appeal claims, contact Coding or Clinical divisions for needed changes or additional documentation to submit with claims. This would include printing claims and attaching clinical documentation as needed.
Successful candidates will have prior medical billing or follow up experience, preferably related to physician/professional services. Will consider experience related to other revenue cycle areas (i.e., Prior authorization) or medical insurance experience with medical claim processing experience. Basic understanding of medical terminology and processes. EPIC experience.
REPRESENTATIVE RESPONSIBILITIES
Billing
- Compile and prepare patient charges.
- Prepare invoices billings, UB-04 and 1500 claim forms to be sent to 3rd party payers for payment indicating individual line items for services and total costs.
- Review charges.
- Obtain and evaluate family, third party payers and agency resources for payment of charges.
- Managing patient billing and ensure procedures are billed according to contracts, transmit or mail all paper and claims, and review correspondence and follow up as needed.
Financial Support
- Obtain and evaluate family, third party payers and agency resources for payment of charges.
- Counsel patient on third party coverage and present financial aspects.
- Determine eligibility for State Medicaid, Social Security and other outside funding.
- Complete necessary paperwork for eligible patients, including medical and financial applications.
- Coordinate inpatient and outpatient admissions.
- Coordinate information with the inpatient and outpatient charge systems.
- Input charges and relative information.
- Manage accounts receivable data and collection information, ensure timeliness and accuracy.
- Research third party payers and community physician charges in order to maintain usual and customary as will as competitive charges.
- Check and update charge master.
- Conduct utilization review for the division from insurance companies and working in conjunction with Cincinnati Children's Utilization Review department.
- Process, post, and balance payments to accounts timely, accurately, and in the correct period.
Systems Support
- Maintain and update departmental system, including templates, and payer and physician information.
Collaboration
- Act as a preceptor for new employees.
- Perform specialty services functions.
- Act as a resource within the department/division.
- Provide instruction for performing non-routine functions.
- Serve as a liaison between Physicians Billing Service, Admitting, Outpatient Surgery, Outpatient Department, Patent Financial Services and other Cincinnati Children's departments.
Quality
- Provide Quality Assurance reports for the division.
Qualifications
- High school diploma or equivalent
- 2 years of work experience in a related job discipline.
About Cincinnati Children's Hospital Medical Center
At Cincinnati Children’s, we come to work with one goal: to make children’s health better. We believe in a team approach, both in caring for patients and their families, and in advancing science and discovery. We strive to do better, and find energy and inspiration in our shared purpose. If you want to be the best you can be, you can do it at Cincinnati Children’s.
More Jobs from This Employer
https://careers.nyssos.org/jobs/18321410/professional-billing-claims-follow-up-rep-ii
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