Billing Representative

Responsible for accurately preparing, submitting, and following up on claims to ensure timely and correct reimbursement while complying with regulatory and payer requirements.

Key Responsibilities

• Review patient accounts for accuracy and completeness of charge, insurance, UB, and DRG information
• Verify billing data, charges, and required claim information
• Submit claims via the appropriate mode of submission
• Maintain compliance with Medicare, Medicaid, and commercial payer regulations
• Document billing actions and updates in the billing system
• Monitor outstanding claims and follow up as needed
• Resolve claim rejections and denials through follow-up and corrections
• Respond to correspondence and phone inquiries regarding claims, charges, and billing discrepancies
• Calculate charge prorations, payer discounts, allowances, and account adjustments
• Communicate effectively with patients, insurance companies, and internal/external departments
• Maintain strict confidentiality of patient health information in accordance with HIPAA regulations
• Perform related duties as assigned