Position Summary

The Patient Accounts Billing Representative is responsible for reviewing unbilled claims and bills, ensuring timely billing and claim resolution to expedite payment. Process all accounts in order to minimize billing time and maximize cash flow.

Completes the editing of claims in the HIS system. Completes the processing of claims either on paper or electronically to third-party carriers. Completes follow-up on aged accounts as directed. Review trial balance reports and processed late charges.

Essential Functions and Responsibilities Includes the Following:

1. Understands and adheres to the WPH Performance Standards, Policies and Behaviors.

2. Insure adherence to federal and state billing regulations

3. Completes accurate billing to all third-party insurance carriers.

4. Monitors host system and biller scrubber to insure timely resolution of unbilled accounts.

5. Completes review of third-party trial balance reports within the current month.

6. Researches and initiates refunds to patients or insurance carriers as needed.

7. Sends inquiries to patients regarding inaccurate or incomplete information.

8. Completes charge adjustments and allowances entries on accounts as needed.

9. Recodes accounts by insurance carrier and plan number and enters into the HIS for re-billing purposes.

10. Processes rejections on third party accounts.

11. Reviews mail correspondence and responds accordingly.

12. Review online billing edits for errors, corrections or missing information. Enter the necessary corrections into HIS.

13. Assists with telephone calls as needed.

14. Completes rebilling process for late charges on a daily basis

15. Monitors host system and bill scrubber for billing delays and to expedite processing.

16. Performs all other related duties as assigned.

Education & Experience Requirements

High School Graduate required. Clerical experience. Required.

Clerical and business aptitude with one to two years' hospital experience.

Ability to use basic office equipment and knowledge of CTR computer terminals a plus.

Medical terminology is helpful but not mandatory.

Core Competencies

Ability to cooperate with others.

Must be able to speak, write, understand and communicate the English language.

Effectively communicate with internal and external customers.

Integrity to handle the confidential aspects of work.

Retains composure under stress

Physical/Mental Demands/Requirements & Work Environment

May be exposed to chemicals necessary to perform the required tasks. Any hazardous chemicals the employee may be exposed to are listed in the hospital's SDS (Safety Data Sheet) database and may be accessed through the hospital's Intranet site (Employee Tools/SDS Access). A copy of the SDS database can also be found at the hospital switchboard, saved on a disc.

Must be able to remain in a stationary position 50% of the time

The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc.

The person in this position frequently communicates with insurance and patients who have questions must be able to exchange accurate information in these situations.

Primary Population Served

Check appropriate box(s) below:

Neonatal (birth – 28 days)

Patients with exceptional communication needs

Infant (29 days – less than 1 year)

Patients with developmental delays

Pediatric (1 – 12 years)

Patients at end of life

Adolescent (13 – 17 years)

Patients under isolation precautions

Adult (18 – 64 years)

Patients with cultural needs

Geriatric (> 65 years)

All populations

Bariatric Patients with weight related comorbidities

Non-patient care population

The responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of White Plains Hospital.