Patient Account Representative - Biller

North Carolina Specialty Hospital (NCSH), is a private, physician-owned medical center that opened its doors in 1926. North Carolina Specialty Hospital's commitment to growth and continuous improvement has helped the hospital maintain a number of high rankings in both quality measures and patient satisfaction. North Carolina Specialty Hospital offers surgical specialties in orthopedics, ophthalmology, ear, nose and throat as well as sports medicine, oral, plastic, podiatry, general surgery, interventional radiology, pain management, reconstructive surgery and more.

GENERAL SUMMARY OF DUTIES:

Responsible for assisting with all functions associated with billing and third party payers. Must be an effective communicator who can express himself/herself on a daily basis in a professional manner both verbally and in writing as well as be a proactive professional who can identify collection trends and solve them in a timely manner. This position is on-site at our Durham, North Carolina location.

ESSENTIAL FUNCTIONS:

• Processes the daily claims batch and uploads the batch to our claims clearinghouse, Waystar, in a timely manner.
• Resolves the daily Waystar claim edit rejections and escalates any unresolved issue to manager in a timely manner.
• Resolves all assigned claim Rejections and/or Returned To Provider claim edits from Medicare via eSolutions in a timely manner and escalates to Manager new issues as needed.
• Processes and reviews the daily PRC-EBO, PRC BD placement files and assures balances are placed appropriately to the agency.
• Processes the daily Final Letter notices for mailing.
• Works and finds billing resolution for all claims rejecting in the daily Biller Desktop tool in Meditech
• Processes daily Late Charges in a timely manner.
• Provides the supporting documentation for all Approved Self Refunds to Barry Howell for final processing.
• Responds to all Attorney requests for Billing Records in a timely manner.
• Follows up on FB account status via the Monthly Period End A/R Report by reviewing the listed accounts to determine if the claim has been accepted and processed for payment or denied.
• Effectively and timely identifies the root cause of non-payment denials and works with the insurance company, the patient and allied healthcare support staff to find resolution to claim denials, making all necessary claim and account corrections to ensure the full reimbursement of services rendered.
• Appropriately escalates denials via the payer Appeals process, and obtains all needed documentation to support the appeal escalation.
• Contacts insurance carriers, patients or guarantors at established intervals to follow-up on status of delinquent accounts, determines the reason of delay and expedites payment.
• Responds in a timely and effective manner to all insurance correspondence inquiries received on assigned accounts.
• Uses effective time management skills to prioritize work flows and respond to claim denials in a timely manner. Placing focus on Inpatient and over 3K high dollar accounts first and then switching to an all high to low, old to new methodology to ensure the Accounts Receivables are worked from an all angle perspective.
• Appropriately assigns the correct Status, Denial Date, Appeal Deadlin Date, Root Cause, Comments and Follow-Up Date to each reviewed account listed on the Monthly Period End A/R Report to help ensure that the correct statistics and follow-up is being assigned to the account.
• Maintains an average score of 3 or more on the monthly Report Card Evaluations.
• Works on special projects as assigned and seeks Team Lead guidance to help achieve departmental goals.
• Provides specific timely feedback to Team Lead regarding denial trends, system and payer specific issues.
• Helps department identify front end solutions to claim denials geared at improving Clean Claim submission and decrease denials.
• Keeps up to date of assigned payer regulation changes, notices and bulletins and ensures all information is shared with Team Leader, Manager and staff in a timely manner.
• Attends in-services and seminars to stay abreast of current issues affecting reimbursement, billing and collections for all payers. Maintains files and documentation of current regulations and guidelines in the shared Payer Folders.
• Provides patient-focused customer service to assist patients with questions or problems in a courteous and effective manner.
• Adheres to all Hospital Policies and Procedures, specifically Guidelines for Appropriate Conduct, Corporate Compliance, Diversity, and Confidentiality.
• Demonstrates the spirit of the philosophy, mission, and values of the hospital through words and actions and implements them into departmental processes, programs, and the working environment.
• Adheres to Confidentiality Policy.
• Maintains positive working relationships and fosters cooperative work environment.
• Adheres to the hospital's "Guidelines for Appropriate Conduct" in the HR Manual.
• Displays honesty and mutual respect when communicating with peers and other departments.
• Follows through on problems that may compromise effective job performance by using appropriate chain of command: Team Leader, Manager and CFO

EDUCATION, EXPERIENCE & QUALIFICATIONS:

• Must have functional knowledge of medical terminology
• Two (2) to three (3) years' experience in patient accounting preferred.
• Experience in a healthcare/ surgery setting preferred.
• CPT Coding Certification preferred
• Effective communication skills; both orally and written.
• Computer skills needed.
• Strong problem-solving skills.
  

Our employees are critical to our success and we value their contributions. North Carolina Specialty Hospital offers a competitive compensation and benefits package and an opportunity to grow and develop your career in an environment that values employee ideas and diversity. Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled. We maintain a drug-free workplace and require pre-employment drug screening and background check.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.