Sr Billing Representative

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

Position is responsible for analyzing patient accounts, researching account history and determining the appropriate information for billing patients’ third party insurance carriers within a specific time period.Job Description

Minimum Qualifications

Education: (None)

Licenses/Certifications: (None)

Experience / Knowledge / Skills:

• Three (3) years hospital/medical insurance billing experience involving public contact, use of computers and related software, medical terminology and forms completion
• Must have knowledge of third party billing procedures as well as state and federal regulations governing billing
• Proficient PC skills including: Microsoft Word processing, Excel spreadsheet data entry & construction of new data sheets, Access database, Microsoft Outlook, Electronic Billing system, Imaging software and calculator by touch
• Must have strong analytical and problem solving skills, statistical analysis, maintaining intense concentration, and the ability to handle multiple priorities and/or special projects

Principal Accountabilities

• Prepares third party billing of Medicare, Medicaid, Blue Cross, Champus, HMO’s, PPO’s, POS’s Workers’ Compensation and Special Contracts. Remain current on changes in billing and payment requirement for all third party payers. Prepare billing for recurrent accounts, Audit treatment and/or encounter dates for Medicare and Medicaid claims to ensure the 72 hr and Lab compliance rules not violated. 
• Analyzes accounts for errors, adjustments and credits, issuing corrected entries when necessary. Updates account information accordingly.
• Communicates with other hospital departments: Medical Records, Business Office, Accounting, Labs, Physical Therapy, Infusion suites, Radiology and Materials Management to clarify coding or charges needed to complete billing process. Call Insurance Companies and/or patients to obtain missing or necessary information to complete the billing process.
• Maintains working knowledge of ICD9 and CPT4 codes for specified services rendered
• Monitors regulations set in place by compliance programs to maintain conformity. Review treatment and/or encounter dates for Medicare & Medicaid claims to ensure compliance of governmental regulations.
• Utilizes computer skills of various software packages: Microsoft Office, Excel, Word, Power Point Electronic billing, System on-line reporting programs, Electronic Mail, data base management and systems/mainframe/file server applications. Utilize TDH online Medicaid eligibility systems to verify correct recipient numbers and Medicare DDE online system to verify information prior to billing, enter a correction or void claims.
• Prepares daily, weekly and monthly reports , maintain and monitor 72 hour reports, lab compliance reports, error forms, return mail procedures, productivity reports and other departmental reports. 
• Mentors and serves as a resource for less experienced staff.
• Assists with the development of policies and procedures.
• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.
• Other duties as assigned.