Professional Billing-Finance Rep II

Job Responsibilities

Billing - Compile and prepare patient charges. Prepare invoices, UB-04 and 1500 claim forms to be sent to third party payers for payment indicating individual line items for services and total costs. Review charges. Obtain and evaluate family, third party payers and agency resources for payment of charges. Managing patient billing and ensure procedures are billed according to contracts, transmit or mail all paper and claims, and review correspondence and follow up as needed.

Systems Support - Maintain and update departmental system, including templates, and payer and physician information.

Collaboration - Act as a preceptor for new employees. Perform specialty services functions. Act as a resource within the department / division. Provide instruction for performing non-routine functions. Serve as a liaison between Physicians Billing Service, Admitting, Outpatient Surgery, Outpatient Department, Patient Financial Services and other Cincinnati Children's departments.

Financial Support - Obtain and evaluate family, third party payers and agency resources for payment of charges. Counsel patient on third party coverage and present financial aspects. Determine eligibility for State Medicaid, Social Security and other outside funding. Complete necessary paperwork for eligible patients, including medical and financial applications. Coordinate inpatient and outpatient admissions. Coordinate information with the inpatient and outpatient charge systems. Input charges and relative information. Manage accounts receivable data and collection information, ensure timeliness and accuracy. Research third party payers and community physician charges in order to maintain usual and customary as well as competitive charges. Check and update charge master. Conduct utilization review for the division from insurance companies and working in conjunction with Cincinnati Children's Utilization Review department. Process, post, and balance payments to accounts timely, accurately, and in the correct period.

Quality - Provide Quality Assurance reports for the division.

Job Qualifications

High school diploma or equivalent

2+ years of work experience in a related job discipline

About Us

At Cincinnati Children's, we come to work with one goal : to make children's health better.