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Patient Financial Services Biller
Prisma Health. Provides accurate and timely submission of claims to various payer sources based on timely filing guidelines .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in hospital claims processing, billing follow-up, and payer guidelines, ensuring accurate and timely submission of claims while maintaining compliance with regulations. Strong focus on resolving payment discrepancies and enhancing departmental productivity through effective communication and attention to detail.
Highest-signal resume keywords
Hospital Claims ProcessingBilling Follow-UpPayer Guidelines KnowledgeAttention to DetailCommunication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims SubmissionPayment PostingReimbursement AnalysisClaim Edits ResolutionDenial ManagementAged Account Follow-UpPayer Variance IdentificationAccount CorrectionsPaper Claims ProcessingCompliance Adherence
Soft Skills
Communication SkillsAttention to Detail
Certifications & Qualifications
CRCACRCR
Industry Keywords
Hospital ClaimsPayer SourcesSpecialty AccountsTechnical DenialsPatient Liability BalancesDelinquent Account StatusStandards of BehaviorsCompliance with Laws and Regulations
About the role
Key responsibilities & impact- Provides accurate and timely submission of claims to various payer sources based on timely filing guidelines
- Follows up on specialty accounts, with increased focus on aged and high-dollar accounts
- Compares expected to actual reimbursement and pursues identified payer variances
- Works with departments to resolve missing payments, payer delays, and technical denials
- Ensures insurance payments are correct and posted to accounts
- Reviews accounts after payment posting to determine secondary payer or patient liability balances
- Resolves discharged-not-final-billed/stop-bill errors and claim edits
- Processes daily paper claims for primary and secondary claims
- Follows up on specialty accounts receivable and rebills rejected claims when appropriate
- Identifies root causes of non-payment denials and coordinates claim and account corrections
- Escalates accounts to payers or internal teams as appropriate
- Identifies system issues through trending and repetitive actions
- Communicates specific errors to Prisma Health department teams for correction
- Contacts payers, patients, or guarantors regarding delinquent account status and expedites payment
- Meets daily productivity and quality goals and contributes to department goals
- Performs other duties as assigned
Requirements
What you’ll need- High School diploma or equivalent OR post-high school diploma/highest degree earned
- Three (3) years in hospital claims and billing follow-up
- Understanding of hospital and physician claim forms
- Knowledge of payer guidelines
- Maintains professional growth and development through seminars, workshops, in-service meetings, current literature and professional affiliations
- Understands, promotes and adheres to all matters of compliance with laws and regulations
- Understands the Standards of Behaviors
- CRCA preferred
- CRCR preferred
- Communication skills preferred
- Attention to details preferred
Benefits
Comp & perks- Full-time employment
- Day shift