Central Maine Medical Center Claims Processing Billing Representative in United States
At Central Maine Healthcare our team members are committed to providing exceptional care and experiences for our community and for each other every day.
Position Summary: The Claims Processing Billing Representative’s responsibility is to process claims in the most efficient method using paper and electronic media in a timely fashion to ensure a positive cash flow for the regional healthcare system. The use of multiple patient accounting systems and claims processing and scrubbing systems are used.Duties and Responsibilities:1. Review claims using electronic claims software -compliance products, editing and transmitting.2. Completes processing for claims received on a daily basis.3. Works with follow-up staff to determine status of rebilled and aging claims.4. Enters notes on accounts as necessary and accordingly.5. Follows up on claims that are held for errors on a weekly basis. When appropriate, contacts patients, employers or third party payers in order to resolve problems.6. Maintains WIP counts at or below goal.7. Identifies claim problems to include all denials, claim issues, registration errors and other issues for monthly reporting to individual departments/practices.8. Stays informed of changes in the insurance industry relative to billing regulations and requirements.9. Consults with other departments within the regional healthcare system to obtain, and/or verify billing information.10. Processes and completes all job responsibilities in compliance with regulatory requirements.11. Works independently to resolve account problems.12. Demonstrates the ability to be flexible, organized and function well in stressful situations.13. Communicates clearly and accurately with the Supervisor.14. Maintains a good working relationship within the department and with other departments of the regional healthcare system.15. Follows through, in a timely manner, on all action steps requested by supervisor.16. Provides coverage for other team members when necessary, reorganizes workflow as necessary to accomplish this.17. Assists with projects and other assignments when necessary, offering assistance when possible.18. Acts as a resource to the entire Claims Processing team, providing training and support as necessary.19. Adheres to department protocol and Central Maine Healthcare policies and procedures.20. Customer Service: Interacts with all individuals in a consistent manner, providing attention, support, and assistance to foster an environment of exceptional personal service.a. Maintains a pleasant and helpful demeanor, and presents a professional appearance toward all internal and external customers at all times.b. Consistently initiates interaction to provide assistance to individuals who may not be direct customers of the employee (i.e. asks patients who appear to be lost if they need assistance in finding their way).c. Takes appropriate action to recover from a service difficulty, ensuring that the necessary action is taken to affect a resolution to the customer’s problem.d. Conducts all work activities with respect for coworkers, including the maintenance of a pleasant and professional environment, fostering calmness during stressful situations.e. Interacts with supervisory personnel in a professional, supportive and courteous manner, venting emotions appropriate to time and place.f. Demonstrates a commitment to service by consistent attendance and punctuality, scheduling absences according to departmental requirements, and incurring unplanned absences only when unavoidable circumstances exist.Organizational Requirements:21. Adheres to departmental dress code, appearance is neat and clean22. Completes departmental and organizational annual education requirements..23. Reports to work on time and as scheduled, completes work within designated time.24. Wears identification while on duty.25. Uses computerized punch time system correctly26. Completes in-services and returns in a timely fashion.27. Attends annual review and department in-services, as scheduled.28. Attends at least 90% staff meetings annually.29. Represents the organization in a positive and professional manner.30. Actively participates in performance improvement and continuous quality improvement (CQI) activities.31. Complies with all organizational policies regarding ethical business practices.32. Communicates the mission, ethics and goals of the facility, as well as the focus statement of the department.Organizational Requirements:33. Confidentiality: Maintains confidentiality of information at all times.a. Consistently maintains confidentiality of all information gained during the course of employment, respecting the privacy of others.b. Understands and maintains the confidentiality of information communicated directly from the supervisor, including discussions of a counseling nature.c. Follows policies and procedures related to medico legal matters, including confidentiality, amendments of medical records, patient rights, medical records as legal evidence and informed consentd. Copies records according to policy, assuring the appropriateness of the individual requesting information from the record prior to copying, faxing, or phoning any portion of the record.34. Safety: Demonstrates an understanding of fire and electrical safety, infection control, body mechanics, and related areas, as appropriate to position.a. Attends mandatory in-services on fire safety, electrical safety, infection control, and body mechanics. Successfully completes competency-based training in each area.b. Follows all employee health procedures, incident reporting, and infection control requirements at all times, as appropriate to the position.c. Uses proper body mechanics at all times as required by the physical demands of the position.d. Maintains a safe work environment and performs duties of the position in a manner consistent with ensuring the safety of self and others.e. Identifies safety needs in areas outside own work environment, recommending corrective action as appropriate.35. Expense Control: Performs job duties in a manner that maximizes expense control.a. Uses supplies, equipment, and utilities in an expeditious mannerb. Consistently recommends methods to control costs while maintaining a high degree of customer service.c. Performs job tasks efficiently and effectively resulting in no unplanned overtime.Regulatory Requirements:• High School graduate or equivalent.• Minimum of two years relevant experience, including knowledge of insurance billing and medical terminology• Thorough understanding of various insurance plans, government agencies, Medicare and Medicaid.Language Skills:• Able to effectively communicate in English, both verbally and in writing.• Strong written and verbal skills.• Additional languages preferred.Skills:• Basic computer knowledge.• High level of interpersonal and communication skills.Physical Demands:• For physical demands of position, including vision, hearing, repetitive motion and environment, see following description.Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising client care.
If you are passionate about making a difference and are looking for your next great career opportunity, we look forward to reviewing your application!