Business Services Representative

Job Description

Job Description

Description:

ESSENTIAL FUNCTIONS:

1. Promptly take all incoming customer service calls regarding patient accounts, insurance coverage, statements, and answer any additional questions patients may have relating to complex insurance coverage and billing questions. In addition, communicate with different insurance companies to gather distinctive information about coverage, eligibility, prior authorizations, co-pay levels, deductibles, etc.
2. Prepare and process insurance claims timely and accurately to commercial, government, and contracted payers.
3. Works claim edits and denials within billing software applications timely and accurately, ensuring correct filing of insurance claims.
4. Thorough in posting charges, payments and adjustments comprised from services rendered per Piedmont HealthCare contracts.
5. Confidently make outgoing calls to patients regarding outstanding balances, both current and collection amounts. In turn, encourage patients to either make a payment or set up a payment plan to avoid being sent to a collection agency.
6. Assertive in assisting and formulating a consistent payment plan that is healthy for each patient’s budget.
7. Thorough understanding and compliance with federal and state billing regulations including protected health information.
8. Communicate with satellite offices to research and configure activity in patient accounts, such as visits, coding, billing, etc.
9. Willingly assist with all customer service related functions to grow business and create positive patient relations.

EDUCATION:

Required: High School Diploma

Preferred: Associates Degree in Business, Finance, Health Information Management, or a related field.

EXPERIENCE:

Minimum of two years related experience. Physicians office, Hospital or Health Insurance Claims Processing. Proficient working knowledge of CPT & ICD 10 and other terms as related to claim reimbursements. Responsible for Insurance claim follow up and obtaining timely reimbursement.

Special Skills:

Fast learner, comfortable with communicating clinical information from the medical record to insurance companies for claim follow up and reimbursement. Exceptional customer service skills, MUST be a master at multi-tasking, a quick learner with outstanding computer skills, excellent communicator both written and verbal. Minimum 2 years related experience.

KNOWLEDGE AND SKILL REQUIREMENTS:

• High regard to the Mission and Vision of all Piedmont HealthCare practices, methods and values along with all organizational policies, procedures and systems
• Strong knowledge of the Piedmont HealthCare Compliance Plan including HIPAA regulations and OSHA guidelines/standards
• General knowledge of insurance filing, reimbursement, and coding (CPT/ICD 10 specifically)
• Understand medical terminology and have the ability to read a medical record
• Experienced in using Microsoft Office 365 tools (Word, Excel, Outlook).
• Excellent PC operating skills (keyboard, mouse) with the ability to multi-task using multiple software applications
• Ability to navigate dual monitor work station
• Competent in managing accounts receivable efficiently
• Proactive in planning, organizing, and strategizing
• Excellent communication and writing skills
• Self-reliant in taking initiative and exercising independent judgment
• Enthusiastic in working effectively with staff, patients and physicians
• Ability to adapt and deal courteously with internal and external customers in a fast-paced environment
• Ability to make good judgments in demanding situations
• Ability to react to frequent changes in duties and volume of work
• Ability to listen empathetically
• Ability to logically and accurately organize details
• Ability to manage multiple tasks with ease and efficiency
• Self-starter with a willingness to try new ideas
• Ability to work independently and be result oriented
• Positive, can-do attitude coupled with a sense of urgency
• Effective interpersonal skills, including the ability to promote teamwork
• Strong problem-solving skills
• Broad knowledge of health care business office practices and principles
• Basic math skills and knowledge of general accounting principles
• Maintain confidentiality of sensitive information
• Knowledge of Business Services policies and procedures
• Knowledge of local, state and federal healthcare regulations

ENVIRONMENTAL/WORKING CONDITIONS:

Normal office environment with evening or weekend work upon request.

PHYSICAL/MENTAL DEMANDS:

Requires the ability to lift up to 10 pounds and occasionally lifting and/or carrying articles such as coding books, reams of paper, etc.

Requires prolonged sitting, some bending, stooping and stretching. Requires eye/hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment.

Requires normal range of hearing, speaking voice, and eyesight to prepare and communicate claims, letters, and reports.

Requires the ability to discuss sensitive matters with patients, staff members and physicians. The position requires the ability to maintain composure when dealing with difficult people and situations.