Physician Billing Representative I

Job Description

The Physician Billing Representative is responsible for various tasks in the Accounts Receivables reconciliation process including but not limited to: examining, correcting and consistently updating Patient Health Information to ensure accurate insurance billing/payment/follow-up; submit bills electronically to payers using designated claims software for the corporation; reviewing rejected claims in such billing software to scrub claims and send them clean to the payer to avoid denials; applying appropriate contractual and self-pay adjustments; resolving patient and insurance carrier inquiries; communicate with physician offices, as necessary, to obtain authorizations or notify them of medically unnecessary orders for diagnostics; using on-line systems provided by multiple payers to verify eligibility and benefits and checking claim status; maintain appropriate/ consistent documentation on accounts worked; apply proper account management principals to accounts to ensure accurate billing; identify non-payment trends by payer and notify management; work based on goals set by management for productivity of validated claims being submitted on a daily basis; makes account corrections as necessary to ensure prompt payment of claims, regardless of which department is responsible for obtaining this information; prints and mails medical records and itemized statements as necessary for payers requiring paper claims submissions; if necessary, phones patients or employers to verify health insurance or worker's compensation information in order to submit claims timely and accurately; maintains a high level of professionalism and communication when it comes to working with other areas of the business office or revenue cycle in an effort to submit bills timely and accurately.

Responsibilities

• Responsible for billing process for patient accounts including but not limited to: examining, correcting and consistently updating patient health insurance claims to ensure prompt insurance payment/follow-up.
• Resolves patient and insurance carrier inquiries related to billing for the revenue cycle.
• Uses on-line systems provided by multiple payers to verify eligibility and benefits and checking claim status appropriately.
• Makes telephone calls to the payer to inquire about denial trends in billing to ensure claims are sent "clean".
• Maintains appropriate/consistent documentation on accounts worked within the patient accounting systems.
• Reviews memos on accounts within patient accounting systems for all reprinted or rebilled claims to ensure any necessary updates/changes are made before submission to the payer.
• Identifies non-payment trends by payer and notifies systems coordinators and management in order to change billing tables to bill accurately or to adjust off timely, to reduce number of A/R days.

Qualifications

Minimum Education

• High School Diploma or Equivalent Required

Minimum Work Experience

• 6 months relevant revenue cycle experience (patient access, financial assistance, insurance billing, patient and/or insurance collections, reimbursement, customer service, payer contracting, or coding) Required
• experience in a healthcare insurance biller Preferred

About Us

Baptist Health Care is a not-for-profit health care system committed to improving the quality of life for people and communities in northwest Florida and south Alabama. The organization includes three hospitals, four medical parks, Andrews Institute for Orthopaedic & Sports Medicine, and an extensive primary and specialty care provider network. With more than 4,000 team members, Baptist Health Care is one of the largest non-governmental employers in northwest Florida.