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Description

At Cincinnati Children's, we believe in nurturing employees' lives as well as their careers. Our benefits equal or surpass other hospitals in the region, and we're proud to offer one of the best working environments in our field to include opportunities to advance your career within our organization. Our benefits help you manage your health, protect you if you are unable to work, help you further your education, and prepare for retirement.

As a Professional Billing Claims Follow Up Representative you will be responsible for reviewing claims edits and denials, making claim corrections, and ensuring accurate billing to commercial and government payors. In addition, following claims once submitted to the payors; Investigating and resolving denials, follow up with payors, appeal claims, contact Coding or Clinical divisions for needed changes or additional documentation to submit with claims. This would include printing claims and attaching clinical documentation as needed.

Successful candidates will have prior medical billing or follow up experience, preferably related to physician/professional services. Will consider experience related to other revenue cycle areas (i.e., Prior authorization) or medical insurance experience with medical claim processing experience. Basic understanding of medical terminology and processes. EPIC experience.

SUBFUNCTION DEFINITION: Prepares and forwards patient claims to appropriate third-party payers. Analyzes and reviews claims to ensure that payer-specific billing requirements are met. Follows up on billing, determines and applies appropriate adjustments, answers inquiries and updates accounts as necessary.

REPRESENTATIVE RESPONSIBILITIES

Billing

• Compile and prepare patient charges.
• Prepare invoices billings, UB-04 and 1500 claim forms to be sent to 3rd party payers for payment indicating individual line items for services and total costs.
• Review charges.
• Obtain and evaluate family, third party payers and agency resources for payment of charges.
• Managing patient billing and ensure procedures are billed according to contracts, transmit or mail all paper and claims, and review correspondence and follow up as needed.

Financial Support

• Obtain and evaluate family, third party payers and agency resources for payment of charges.
• Counsel patient on third party coverage and present financial aspects.
• Determine eligibility for State Medicaid, Social Security and other outside funding.
• Complete necessary paperwork for eligible patients, including medical and financial applications.
• Coordinate inpatient and outpatient admissions.
• Coordinate information with the inpatient and outpatient charge systems.
• Input charges and relative information.
• Manage accounts receivable data and collection information, ensure timeliness and accuracy.
• Research third party payers and community physician charges in order to maintain usual and customary as will as competitive charges.
• Check and update charge master.
• Conduct utilization review for the division from insurance companies and working in conjunction with Cincinnati Children's Utilization Review department.
• Process, post, and balance payments to accounts timely, accurately, and in the correct period.

Systems Support

• Maintain and update departmental system, including templates, and payer and physician information.

Collaboration

• Act as a preceptor for new employees. Perform specialty services functions.
• Act as a resource within the department/division.
• Provide instruction for performing non-routine functions.
• Serve as a liaison between Physicians Billing Service, Admitting, Outpatient Surgery, Outpatient Department, Patent Financial Services and other Cincinnati Children's departments.

Quality

• Provide Quality Assurance reports for the division.

Qualifications

EDUCATION/EXPERIENCE

Required:

• High school diploma or equivalent
• 2 years of work experience in a related job discipline.

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