Advanced Patient Representative

Primary Scheduled Hours: Days, 80 hours per pay period

Job Summary:

Responsible for medical billing functions and submission of claims to third-party payers for payment. Reviews claims to verify accuracy and completeness of charges; researches denied or incomplete bills; submits secondary claims, claim adjustments, and corrected claims as needed; submits letters of appeal with proper documentation to insurance carriers. Works closely with district departments, providing updates regarding codes, benefit limits, or changes for patients' health insurance, including state and federal programs. Interacts with patients regarding medical benefits, processes patient payments, and resolves minor billing complaints. Monitors insurance EOB payments for amount paid and accuracy.

Essential Job Functions:

• Interacts daily with patients/families regarding billing problems and insurance issues.
• Investigates and follows up on questions/issues to resolve concerns accurately and timely, communicating information to staff as needed.
• Maintains working knowledge of services offered and applicable insurance guidelines regarding eligibility and reimbursement.
• Assists patients and insurance companies with billing issues, ensuring confidentiality of patient records.
• Compiles hospital claims, completes appropriate forms, and submits claims to proper agencies/insurance companies electronically and/or by paper.
• Recognizes outstanding account/insurance balances (aging) and determines appropriate action.
• Applies knowledge of claim submission, including CCI edits, modifiers, medical necessity rejects, and late charges for Medicare, Medicaid, and other government and commercial carriers.
• Prepares credit balance documentation for insurance carrier overpayments.

Education Background and Experience Requirements

Minimum Education (Attested)

High School graduate or equivalent, or equivalent relevant experience.

Required Licensure / Certification

AAHAM Certified Revenue Cycle Specialist, Institutional (CRCS-I) certification; or other related billing certification or degree.

Required Experience (Attested)

Three (3) years medical billing experience required.

Preferred Qualifications

Comprehensive knowledge of claim submission for multiple payers; in-depth understanding of Medicare and Medicaid programs and patient benefits.

Professional Requirements:

• Maintain regulatory requirements
• Report to work on time and as scheduled; complete work within designated timelines.
• Demonstrates the ability to adhere to the mission, ethics and goals of the District.
• Demonstrates the ability to communicate with patients, guests and staff in a courteous, respectful and helpful manner.

Compensation/How We Care For You:

Successful candidates typically begin between the beginning and midpoint of the compensation range dependent on qualifications/experience and receive compensation in increments increases annually.

Comprehensive benefit package including:

• Medical/Dental/Vision
• Retirement with a 6% dollar for dollar employer match
• Life and Disability Insurance
• AFLAC
• Flexible Spending Account
• Employee Assistance Program
• Bonus, if eligible upon Board approval
• Gym membership
• Tuition Reimbursement and Student Loan Repayment Opportunities

Newport Hospital & Health Services (NHHS) is committed to a diverse and inclusive workplace. NHHS is an equal opportunity employer and does not discriminate based on race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status.

NHHS employs only U.S. citizens and lawfully authorized non-U.S. citizens. All new employees must show employment eligibility verification as required by the U.S. Citizenship and Immigration Services.

NHHS is committed to providing access and reasonable accommodation in its services, programs, activities, education and employment for individuals with disabilities.