Billing Follow-Up Representative

Located at our Core Lab (Moraine, OH)/Remote Shift Availability 

Full-Time Day Shift

Position Summary:

Under the supervision of the Billing Department Manager: perform the daily account processing tasks of the Billing Department including billing data entry, third party billing and follow up; review denials and resubmit claims; answer incoming as well as place outgoing calls to both patients and clients while maintaining positive internal and external working relationships with patients, clients and third party payers.

Essential Duties and Responsibilities Assigned

• Maintain organized workflow to allow efficient processing of accounts and to enable smooth transition of job duties during absences.
• Follow department standard processes. Consult with immediate supervisor when questions regarding appropriate account processing arise.
• Exhibit good customer service skills when dealing with internal and external customers. Project a positive image of the department and organization.
• Actively engage in behaviors that foster teamwork within the department and organization.
• Meet or exceed department standards for quantity and quality of work.
• Possess working knowledge of relevant compliance regulations. Effectively apply this knowledge to daily job duties.
• Comply with all departmental, company and regulatory policies and procedures.
• Maintain statistical data as required.
• Additional duties and projects as assigned.

Specific Departmental Job Duties as Assigned:

• Ability to accurately perform order entry.
• Research and resolve any missing information from the Client orders.
• Ability to use translation tools to enter codes received from other departments into the appropriate billing systems.
• Strong communication skills needed for collaboration with both internal and external departments as well as patient/client calls.
• Apply payment detail to client and patient accounts, including contractual disallowances, and patient copays/deductibles.
• Review over payments, initiating refunds or correcting misapplied payments as appropriate.
• Knowledge of reading and understanding various payer’s Explanation of Benefits.
• Review un-adjudicated claim reports and contact insurance carriers to determine reason for non-response.
• Perform follow-up as appropriate to resolve outstanding accounts.
•  Process Medicare denials for medical necessity and monitor payer rejections and denials for trends.
• Review claim development reports for insurance denials; contact insurance carriers to determine denial reasons; works with carriers to rectify unpaid claims.
• Ability to handle fast paced, high call volume environment with above average multi-tasking skills.
• Possess strong focus on positive customer impact. Utilize verbal and written communication effectively.
• Research collection accounts as requested by patients or collection agencies.
• Review system error codes and make corrections to accounts.

Qualifications:

• High school graduate or equivalent required.
• Previous experience in medical billing environment preferred.
• Working knowledge of Medicare and other third party claims processing, ICD-10 and HCPS/CPT coding and medical terminology highly desirable.

Safety & Physical Demands:

• Visual acuity and hand-finger dexterity to work at computer for extended periods.
• Sit at computer work station for extended periods.
• Sound reasoning ability and independent judgment.
• Ability to work within specified deadlines and timetables.
• Excellent communication and people skills.
• Handle stressful situations in a calm manner.
• Will not have exposure to biohazard substances and hazardous chemicals.
• Be familiar with and adhere to safety, ergonomic and health policies of the Company.
• Comply with all PPE requirements when in the laboratory or other biohazard areas.
• Complete required safety training and health evaluations in a timely manner.
• Anticipate safety hazards, act upon unsafe situations and promote safety awareness.