Serves as the main Physician Billing (PB) contact for parents / patients and the related Lurie Children’s departments, analyzing and resolving customer service needs, and confirming satisfaction. This position provides office support to the staff, physicians, billing companies and management. Ensures the smooth daily operations of office operations and information management for physician billing services. Supports the Lurie Children’s and PB customer service goals through modeling of appropriate behavior and by providing a work environment conducive to attaining these goals
Essential Job Functions:
- Responds to customer service inquiries and resolves issues when appropriate by performing billing, charge revision (debits or credits), corrections, adjustments, transfers to Lurie Children’s, payment arrangements, discounts, and settlements - ensuring a customer satisfactory interaction.
- Acts as a liaison with insurance or billing company or with Lurie Children’s Patient Financial Services to handle and resolve incoming telephone inquiries related to patient accounts, update billing systems with new or corrected information (eg. demographics or insurance information) received from parents / patients.
- Reviews coding and billing questions received from parents / patients and requests rebills, as appropriate, to assist with customer satisfaction. Takes actions to respond to Lurie Children’s staff, parent / patient billing issues and billing company feedback.
- Handles projects involving process or productivity enhancements, provides billing / denial data to staff and requests specialized reports from billing company.
- Works with Health Information Management to request medical records for insurance appeals, release of information, reviews charts and forwards copies of documentation to billing company for insurance appeal.
- Processes internal transfers between physician billing and hospital billing and processes refund requests for parents / patients, governmental and third party payers.
- Responds to credentialing questions and acts as a liaison between the Faculty Practice Plan (FPP) and billing company. Assists as needed with ad hoc credentialing requests for out of state Medicaid plans.
- Participates in the monthly Lurie Children’s Revenue Cycle meeting by updating the SharePoint web site with Out of Country patient names, preparing agendas and providing copies of reports at the meeting.
- Reviews, works and releases charges through assigned Epic work queues. Able to enter charges and understands Epic work flows for charge entry and account follow up.
- Forwards denials to appropriate PB and clinical staff for assistance in resolving denial issues. Uses reports from Epic’s report work bench to identify denial trends.
- Works with PB management to analyze and identify trends in reimbursement and performs other job-related tasks as assigned.
- Performs job functions adhering to service principles with customer service focus of innovation, service excellence and teamwork to provide the highest quality care and service to our patients, families, co-workers and others.
Knowledge, Skills and Abilities:
- Minimum two years of college with some background in healthcare or business-related courses preferred.
- Excellent customer service skills.
- Experience using and knowledge of Microsoft Office is mandatory. The ability to operate standard office equipment is required. EPIC and IDX knowledge are optional.
- Medical terminology, CPT and ICD-9 coding experience preferred.
- Minimum of three years of business office experience in hospital or physician office setting with significant time spent in communication with patient or family and third party payers.
- Knowledge of physician billing work flow, third party payer procedures, governmental regulations and managed care contracting to effectively understand and to respond to inquiries on patient accounts.