Prepare claims for accurate and timely submission to both patients and third-party payers (e.g., commercial payers, HM - Os, and government payers). Edit and submit claims through the hospital billing system. Review and mail non-electronic hard copy claims as required. Generate itemized bills to payers, patients and other entities. Perform routine follow up to payers and self-pay patients on open balances in order to effectuate collection. Review payer denials and payment variances and work to r... more details
Overview The Accounts Receivable Representative is responsible for managing all aspects of accounts receivables for One Brooklyn Health System including billing, follow-up, customer service and cash posting to ensure maximum reimbursement for services provided. This role recognizes and complies with all confidentiality and regulatory standards for both patient and hospital information and is customer focused with emphasis on accounts receivable management. Responsibilities Prepare claims for accurate and timely submission to both patients and third-party payers (e.g., commercial payers, HMOs, and government payers). Edit and submit claims through the hospital billing system. Review and mail non-electronic hard copy claims as required. Generate itemized bills to payers, patients and other entities. Perform routine follow up to payers and self-pay patients on open balances in order to effectuate collection. Review payer denials and payment variances and work to resolution. Submit appeals as needed. Liaison between third party payers and other hospital departments. Handle correspondence and inquiries as it relates to account payments from patients and other entities. Input of transactions, allowances and refunds to correct balances within the Electronic Medical Record (EMR). Post electronic and manual payments, denials and adjustments to patient accounts with attention to detail. Perform daily and monthly reconciliation and cash balancing functions. Resolve discrepancies in the reconciliation process and work unposted cash. Notify leadership of trends or problems with specific payers or contracts. Consistently document and note changes to patient’s record and action taken on accounts within the EMR in compliance with all hospital and regulatory agency policies. Achieve quality and activity expectations on a regular basis. Other duties as assigned and needed by the department. Qualifications Education: High School diploma or GED equivalent. Some college preferred. Experience: Two or more years of healthcare revenue cycle experience. Experience in healthcare billing and follow-up strongly preferred. Knowledge and Skills: Proficiency with computer systems and Microsoft Office products. Knowledge of CPT and ICD-10 coding; knowledge of commercial and/or government payer rules. Ability to gather information from medical records and reports to support claim resolution. Well-developed problem-solving skills. Excellent written and oral communication skills. Strong customer service skills. Detail oriented; data and report analysis application. Physical Requirements: Position requires prolonged periods of standing, reaching, walking throughout the working day. Position will be required to stoop, bend, lift, and carry items weighing up to 25 pounds. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The statements herein are intended to describe the general nature and level of work being performed by employees, and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of the One Brooklyn Health System. OBHS is an equal opportunity employer, it is our policy to provide equal opportunity to all employees and applicants for employment without regard to race, color, religion, national origin, marital status, military status, age, gender, sexual orientation, disability or handicap or other characteristics protected by applicable federal, state, or local laws.
