Business Services Representative

The Business Service Representative works under the direction of the Business Service Manager. Job duties include review of services provided to determine accuracy; posting all charges, adjustments, and submitting claims to all parties responsible for payment; processing claim for payment; posting payments to the appropriate accounts; reconciling denials, verifying coverage; updating insurance profiles; follow-up of unpaid claims; assists with maintenance of data files; and, other duties, as assigned .

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

- Supports and implements the organization’s vision, mission and value.

- Determines priorities and method of completing daily workload to insure that all responsibilities are carried out in a timely manner.

- Performs all job functions in a professional and courteous manner. This includes answering all general phone calls timely. Provide excellent customer service to internal and external customers by being responsive to all inquiries in a timely manner.

- Fosters and promotes a culture of service excellence and accountability.

- Reviews assigned pending charges to validate accuracy of responsible party, charges (CPT), and diagnosis (ICD)

- Review electronic health and dental systems for charge and diagnosis verification. Communicates electronically with provider of service for missing charges and/or clarity of diagnosis

- Posts all transactions to include charges, adjustments, insurance and patient payments and reconciles postings to the General Ledger. Resolves credit balances via adjustments and/or refund

- Receives, reviews, processes, and submits QueensCare Grant hospital and/or physician claims for payment in accordance to established guidelines.

- Reviews and edits claims listed in the electronic insurance batch system to insure accuracy and transmits same to the insurance carrier(s) for payment.

- Reviews payment denials, underpayments, and payment take backs for appropriateness and produce resolution by resubmission to the insurance carrier, patient billing, or appropriate adjustment.

- Verifies patents coverage via electronic media and document review prior to billing and based on eligibility denial. Update patient insurance profile and claims as needed.

- Reviews patient accounts post -payment and bills secondary insurance carrier when applicable.

- Performs follow-up of unpaid claims via electronic media or telephone.

- Prepares and submits requests for payment statement for patient responsibly. Assigns unpaid accounts to Bad Debt when collection efforts are exhausted.

- Assists Business Service Management with maintenance of data files necessary to perform tasks.

- Performs as a resource with other departments as it relates to issues of insurance coverage and eligibility.

- Complies with organizational policies and procedures.

- Performs all other duties as assigned.

Qualifications

EDUCATION/EXPERIENCE:

- High School Diploma or equivalency and three years of medical billing experience required.

- Must demonstrate a clear understanding of medical terminology, Current Procedural Terminology (CPT) and International Classification of Disease (ICD) coding.

- Working knowledge of billing for a multi-discipline practice and general computer systems required.

OTHER SKILLS AND ABILITIES

- Demonstrates ability and flexibility to work in other areas of the organization as needed.

- Performs work in adherence to company’s policies and procedures.

- Demonstrate required knowledge, skills, education for job functions.