Billing and Follow-up Representative – Hospital Medical Billing Follow-up, Blue Cross Payor
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Job Description
Remote medical billing representative pursuing Blue Cross claims and resolving payment issues for Trinity Health’s hospital revenue cycle. Documenting claims, correcting rejections, and maximizing reimbursement.
Responsibilities:
- Perform day-to-day billing and follow-up activities within the revenue operations of an assigned Patient Business Services location
- Support the revenue cycle process as part of the billing and follow-up team
- Document claims billed, paid, settled, and follow-up in appropriate systems
- Identify and escalate issues affecting accurate billing and follow-up activities
- Contact payers directly regarding payment due on accounts
- Review and respond to mail correspondence accurately and promptly
- Communicate with hospital departments to clarify billing discrepancies and obtain demographic, clinical, financial, and insurance information
- Investigate overpayments, underpayments, credit balances, and payment delays
- Route tasks to correct workflows to maximize reimbursement and ensure claims are paid or settled timely and accurately
- Research claim rejections, make corrections, take corrective actions, and/or refer claims for resolution
- Follow up on delayed payments with patients and third-party payers, determine causes of delay, and provide additional data as required
- Prepare special reports as directed by the Supervisor Billing and Follow-Up
- Perform other duties as assigned
- Maintain knowledge of applicable laws, regulations, Trinity Health policies, and compliance requirements
Requirements:
- High School diploma and at least one (1) year of experience and relevant knowledge of revenue cycle functions and systems in a hospital or clinic environment, health insurance company, managed care organization, or other health care financial service setting
- Experience performing medical claims processing, financial counseling, financial clearance, accounting, or customer service activities, or an equivalent combination of education and experience
- Basic understanding of Microsoft Office, including Outlook, Word, PowerPoint, and Excel
- Completion of regulatory/mandatory certifications and skills validation competencies preferred
- Excellent verbal and written communication and organizational abilities
- Strong interpersonal skills
- Accuracy, attention to detail, and time management skills
- Ability to work independently
- Ability to perform billing and follow-up activities promptly and accurately
- Ability to work in a collaborative, shared leadership environment
- Ability to comply with Trinity Health policies and procedures
- Ability to operate a keyboard and communicate extensively by telephone and in person
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