Patient Representative/Biller, Duncan Regional Hospital

The position is responsible for balances due from patients, insurance carriers, and third-party payers. Team member will collect patient payments, set up payment plans and payroll deductions from team members, follow-up on outstanding insurance denials, work claim error in the clearinghouse system, and post patient and insurance payments for Home Care/Hospice accounts. **RESPONSIBILITIES (ESSENTIAL FUNCTIONS):** - Accurately posts payments and creates payment plans for upcoming services and/or outstanding balances. - Reviews balances and communicates to patient and other affected parties about outstanding balances. - Assists patients in resolving account questions and concerns. - Responsible for coordinating and completing financial assistance application for charity care program. - Responsible for understanding the revenue cycle, including all involved parties and appropriate escalation pathways. - Contacting payers, via website, phone and/or correspondence, regarding reimbursement of unpaid accounts over thirty (30) days or more, also researching and following up on denials and requests for additional information. - Interpret Managed Care/Commercial contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection. - Make necessary adjustments as required by plan reimbursement. - Performs payment validation by utilizing internal and/or external resources to ensure proper reimbursement. - Reviews, researches, and appeals partially denied claims for reconsideration. - Responsible for contacting patients to gain additional information required to resolve an outstanding insurance balance. - Responsible for posting payments both electronically and manually. - Analyzes, investigates, and resolves claims errors in the clearinghouse system to ensure claims are filed to carriers timely. - Regular attendance and punctuality for scheduled shifts. - Maintains professional and technical knowledge through continuing education opportunities including internal and external educational offerings. - Must adhere to safety protocols at all times. - Per DRH policy, all required conditions of employment must be met and maintained including required vaccinations. - Implement DRH Standards of Behavior and exhibit behaviors consistent with DRH core values. - Performs other related duties as assigned. **Minimum Qualifications:** Communication skills including fluency in oral and written English. Basic computer skills including the ability to send/receive email, navigate information technology associated with the position, and use Electronic Health Record information tools. Ability to remain flexible to quickly adapt to urgent situations. Ability to adapt procedures, processes, tools, equipment, and techniques to accomplish the requirements of the position. **Education and/or Experience:** High school diploma or equivalent. At least 1 year of experience in medical claims recovery and/or collections and basic know of billing and collections rules and regulations preferred. Strong Home Care and Hospice medical billing/collections, coding, and denial management experience preferred. Ability to read, interpret and apply policies, procedures, and requirements. Familiarity with standard office equipment. Ability to handle multiple tasks in timely manner. **Certifications, Licenses, Registrations:** For those positions requiring travel, a current valid driver’s license and automobile liability insurance must be maintained. **Non Safety-Sensitive Position** As a condition of employment, vaccinations are required per DRH Policy. Medical and Religious Exemptions are available upon request.