Nebraska Methodist College

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Patient Billing Rep I - MPC Corp Insurance Reimb

at Nebraska Methodist College

Posted: 5/29/2019
Job Reference #: 230621
Keywords: billing, accounting

Job Description

Req Number:

Nebraska Methodist Health System

Located at:
Omaha, NE

Work at :
825 S 169TH ST

MPC Corp Insurance Reimb

Full Time

Day Shift

8am - 4:30pm

Hours Per Week:

Starting Hourly Rate:

Contact Information:
  • Contact: Ashley Batko

Job Details:
  • High School Degree or GED required
    • Purpose of Job
      • Responsible for billing, electronic claims submission, follow up and collections of patient accounts.
    • Job Requirements
      • Education
        • High school diploma, General Educational Development (GED) or equivalent required
        • Coursework in Coding, Billing or Healthcare Management normally acquired through enrollment in a secondary education institution or online classes through the American Heath Information Management Association (AHIMA) preferred.

      • Experience
        • Minimum of one (1) year prior experience in healthcare third party billing and/or claims processing preferred.
        • Prior exposure to UP04 and/or CMS1500 claim data normally acquired through work in a physician’s office or other healthcare setting preferred.

      • License/Certifications
        • N/A

      • Skills/Knowledge/Abilities
        • Skill in interpreting UB04 and/or CMS1500 claim data to be able to troubleshoot claim edits and resolve payer billing requirements both timely and accurately.
        • Ability to create and submit both original and corrected claims.
        • Ability to audit accounts and payer explanation of benefits (EOBs) to determine appropriate action.
        • Ability to use effective communication skills in order to handle patient inquires, attorneys, health system staff and payers on a professional level.
        • Knowledge and understanding of accounting and business principles to enable accurate auditing of patient accounts.
        • Ability to follow up with the 3rd party payers for claims and appeals submitted to ensure timely and accurate processing.
        • Ability to maintain a working knowledge of multiple system applications.
    • Physical Requirements
      • Weight Demands
        • Light Work - Exerting up to 20 pounds of force.

      • Physical Activity
        • Occasionally Performed (1%-33%):
          • Balancing
          • Climbing
          • Carrying
          • Crawling
          • Crouching
          • Distinguish colors
          • Kneeling
          • Lifting
          • Pulling/Pushing
          • Reaching
          • Standing
          • Stooping/bending
          • Twisting
          • Walking
        • Frequently Performed (34%-66%):
          • Hearing
          • Repetitive Motions
          • Seeing/Visual
          • Speaking/talking
        • Constantly Performed (67%-100%):
          • Fingering/Touching
          • Grasping
          • Keyboarding/typing
          • Sitting

      • Job Hazards
        • Not Related:
          • Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)
          • Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)
          • Equipment/Machinery/Tools
          • Explosives (pressurized gas)
          • Electrical Shock/Static
          • Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc)
          • Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)
        • Rare (1-33%):
          • Chemical agents (Toxic, Corrosive, Flammable, Latex)
          • Mechanical moving parts/vibrations
        • Note: Safety Officer can assist with identification of job hazards
    • Essential Job Functions
      • Essential Functions I

        • Electronic and Hardcopy Billing
          • All EDI and paper claims submitted are to be billed as needed following department and payer specific guidelines.
          • Obtains appropriate EOB's through use of health system resources.
          • Reviews Billing Scrubber Claim Detail Screens to ensure data is appropriate for claim submission.
          • Ensure that claim corrections identified in billing scrubber are appropriately updated and documented in Source System.
          • Prepares secondary and tertiary billings, manually and electronically on UB04's and/or 1500's for accurate reimbursement.
          • Submits adjusted UB04/837I and/or CMS1500/837P claims according to department and payer specific guidelines.

        • Display Effective Communication Skills
          • Demonstrates active listening skills.
          • Notifies and keeps leads and supervisors informed on issues identified.
          • Follows telephone etiquette procedures set forth by the organization and/or individual department.
          • Professional/Courteous responses when communicating with customers, health system staff and management.

        • Handling of Referrals
          • Timely and accurately handling of referrals, both regular and escalated priority from management, within department guidelines.
          • Documents clearly and appropriately all referrals (including patient inquiries) in the Source System when necessary.
          • If necessary, follows up with patients on final results of inquiry both timely and professionally. Notifies patient of final results of account handling in question.

        • Knowledge of System Applications
          • Demonstrates ability to learn and maintain a working knowledge on all the current health system applications.
          • Identify/obtain/print medical records as necessary for resolution of denial or system edits according to department guidelines.

        • Auditing of Patient Accounts
          • Understand accounting and business principles to accurately determine the remaining balance on a given encounter.
          • Upon accurately auditing encounter or visit, is able to understand and update proration to make sure dollars are allocated to the appropriate benefit orders if needed.
          • Leverages all needed resources to complete an audit of an account.
          • Documents audit finding and actions taken in Source System when necessary.

        • Claim Follow Up with Third Party Payers
          • Full understanding of all necessary third party billing and follow up processes based on department specifications.
          • Full understanding of all necessary contract related requirements.
          • Leverages payer websites and necessary tools to streamline the follow up process.
          • Appropriate documentation in Source System when necessary.
          • Ability to interpret correspondence assigned for accurate handling.

        • Special Projects and Tasks as Assigned
          • Completion of any assigned projects timely, accurately and to the specifications of leadership.
          • Ensure Daily/Weekly/Monthly assignments are handled accurately and timely.

        • Maintaining Daily Workflow
          • Manages and maintains assigned workflow queues according to department guidelines.
          • Mail/Correspondence processed and handled following departmental guidelines.
          • Documents both timely and appropriately in Source System using proper documentation methods.
          • Fundamental understanding of different work item, state based and exception queues within the Patient Accounting System applications.

      • Essential Functions II

        • Participates in mandatory in-services and/or CE programs as mandated by policies and procedures/external agencies and as directed by management.

        • Follows and understands the mission, vision, core values, Employee Standards of Behavior and company policies/procedures.

        • Other duties as assigned.