Under the direction of the Patient Financial Services Manager, performs third party billing duties and provides support to the PFS group. Professional attitude, good judgment, and high ethical standards are required. Additional tasks or duties may be assigned as determined by management.

ESSENTIAL DUTIES

• Verify and document patients’ third-party insurance eligibility status.
• Data entry of:
  • Demographic patient information
  • Charge entry
  • Posting of payments/contractual allowances
• Claims production:
  • Printing or other preparation of insurance claims, self-pay bills, collection letters.
  • Collecting the Medical Necessity Forms, Narratives, Trip Sheets & Explanation of benefits needed to attach to associated insurance claims
  • Faxing to insurance companies for prior-authorization
  • Bundling claim forms with appropriate documentation
  • Preparing mailings, which includes addressing, stuffing and posting envelopes
  • Preparing appeal letters when needed
  • Keep current on compliance issues including new regulations at the local, state and national level
• Print reports requested by Patient Financial Services Manager and/or CFO
• Contact sending/receiving hospitals or patient’s family (via email or voice) for demographic information
• Monitor claim status and conduct follow-up with insurers/private payers
• Resolve credit balances and initiate refund requests
• Follow-up with patients by phone regarding outstanding balances and offer alternative payment options
• Review mail received and take appropriate action, including documenting receipt in billing record
• Answer phones and assist patients with inquiries about their bills
• Maintains positive communication (written and spoken), effectively while interfacing with fellow employees, patients, referring hospitals, and the community at large

POTENTIAL DUTIES

• Various other administrative duties as assigned

MINIMUM QUALIFICATIONS

• Certification of completion of school for Medical Billing or 1-3 years’ experience in third party billing preferable
• Knowledge of FAX, photocopying, e-mail and computer systems. (e.g. Word, Excel, Billing software)
• The ability to maintain a high level of confidentiality
• Certified EMT or allied health experience preferred.
• Strong interpersonal and communication skills
• Must be able to speak, read, write and comprehend the English language without restriction
• Must be able to maintain peer accountability, be an effective problem solver and maintain professional demeanor and confidentiality at all times
• Must be a self-motivated individual willing to take initiative and able to function with minimal supervision

NOTES

An FBI background check and criminal background check will be performed prior to employment and annually.