Patient Services Representative

Researches insurance claim denials, determines the validity of the claim and when appropriate is responsible for adjusting and resubmitting the claims via multiple methods.

Works with the provider staff, supervisors, and directors of assigned programs to ensure services are authorized, documented and billed in a timely and effective manner.  Input related data into Electronic Health Record (EHR) software according to strictly prescribed procedures. The position is supervised by the Billing/Collections Team Lead. 

DUTIES AND RESPONSIBILITIES:

Maintains a high level of integrity and commitment to accurate benefit verification and claims processing.

Researches and resolves issues related to benefit verification, claim generation, claim rejections, and denied claims.

Communicates with clinical staff regarding coverage and denials, if appropriate

Proactively work to ensure that all necessary eligibility information is received and updated in a timely manner to ensure maximum reimbursement from funding sources.

Monitoring billing activities to ensure compliance with billing regulations governing healthcare and departmental policies.  Demonstrates thorough understanding of ODMHSAS, Medicare, Medicaid, and commercial insurance standards and guidelines.  Applies this knowledge to determine validity of claims and research denial of claims, evaluate and rebill as necessary to ensure the maximum accurate payment and reduce the number of A/R days.

Maintains prescribed performance data and billing/collections metrics.

Communicates issues that are preventing timely and accurate billing to appropriate management.

Consults with provider staff and supervisors regarding record keeping practices and regulations. 

Reviews all incoming clinical documentation to ensure compliance with various funding source requirements related to completion and timeliness standards.  Verifies that all information has been completed as needed.  Evaluates appropriateness of information recorded.  Returns items to clinical managers as needed to request corrections and follows up to ensure that revisions are received.

Assists other agency administrative staff in the research of outstanding receipts, as needed. 

Prepares documentation to request adjustments, corrections, and write-offs to client accounts as necessary prior to system closing or as requested by supervisor.

Acts as liaison between billing department and clinical staff.  Works to foster a cooperative relationship to ensure the best service is provided to the agency. 

Responsible for knowledge and adherence to HIPAA regulations as well as other state, federal and agency regulations related to confidentiality of consumer health information. 

Responsible for notifying supervisor of any training deficiencies that impair ability to perform duties.

Perform other duties as required and/or assigned by supervisor and/or executive staff.

Staff will abide by the agency policy on confidentiality at all times and respect the integrity and confidentiality of all consumer related information.

EOE Statement:  NorthCare provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.