SENIOR PATIENT RELATIONS REPRESENTATIVE - 40000958 (Durham, NC, US, 27701)

DUTIES AND RESPONSIBILITIES

• The essential functions listed below are those that represent the majority of the time spent working in this position. Management may assign additional functions related to the type of work of the position as necessary.
• Accurate review, entry, and submission of self-pay and insurance billing for accuracy (i.e. diagnosis codes, CPT codes, modifiers, patient and provider information and payer specific billing requirements) Processing electronic billing in EPIC Researching and resolving claim issues, non-payments and denials correcting and resubmitting for payment Identifying denials for trends; reporting any findings to appropriate staff Processing accounts receivables Tracking aging accounts via preparing and analyzing reports Communicating directly with patients and payors to resolve any billing/claim issues Correcting patient account errors Processing refunds to patients and/or payers Entering patient approved Presumptive Medicaid insurance coverage into EPIC
• Accurate review, entry, and submission of self-pay and insurance billing for accuracy (i.e. diagnosis codes, CPT codes, modifiers, patient and provider information and payer specific billing requirements)
• Processing electronic billing in EPIC
• Researching and resolving claim issues, non-payments and denials correcting and resubmitting for payment
• Identifying denials for trends; reporting any findings to appropriate staff
• Processing accounts receivables
• Tracking aging accounts via preparing and analyzing reports
• Communicating directly with patients and payors to resolve any billing/claim issues
• Correcting patient account errors
• Processing refunds to patients and/or payers
• Entering patient approved Presumptive Medicaid insurance coverage into EPIC

KNOWLEDGE, SKILLS, AND ABILITIES

• Working knowledge of medical billing principles, payer reimbursement methodologies (including Medicaid, Medicare, and commercial insurance), and healthcare revenue cycle practices. Knowledge of modern office methods, practices, and equipment Knowledge of computer software and the ability to train others on the use of that software Ability to understand and contribute to the process of creating policies and procedures Effective customer service skills General understanding of bookkeeping and accounting principles as they apply to billing, payment posting, accounts receivable, and reconciliation. Familiarity with government budgeting and public health financial procedures, including reporting, auditing, and fee setting. Excellent interpersonal skills and the ability to maintain effective working relationships with clinical teams, administrative staff, the public, and representatives from external agencies. Clear and professional oral and written communication skills; able to present information effectively to staff and leadership. Strong analytical skills with the ability to interpret billing regulations, identify and resolve issues, and apply relevant laws and payer policies. Highly organized with the ability to prioritize tasks, manage competing deadlines, and adapt to changing programmatic or regulatory needs. Proactive, flexible, and open to continuous learning and adopting new approaches to improve efficiency and meet departmental goals.
• Working knowledge of medical billing principles, payer reimbursement methodologies (including Medicaid, Medicare, and commercial insurance), and healthcare revenue cycle practices.
• Knowledge of modern office methods, practices, and equipment
• Knowledge of computer software and the ability to train others on the use of that software
• Ability to understand and contribute to the process of creating policies and procedures
• Effective customer service skills
• General understanding of bookkeeping and accounting principles as they apply to billing, payment posting, accounts receivable, and reconciliation.
• Familiarity with government budgeting and public health financial procedures, including reporting, auditing, and fee setting.
• Excellent interpersonal skills and the ability to maintain effective working relationships with clinical teams, administrative staff, the public, and representatives from external agencies.
• Clear and professional oral and written communication skills; able to present information effectively to staff and leadership.
• Strong analytical skills with the ability to interpret billing regulations, identify and resolve issues, and apply relevant laws and payer policies.
• Highly organized with the ability to prioritize tasks, manage competing deadlines, and adapt to changing programmatic or regulatory needs.
• Proactive, flexible, and open to continuous learning and adopting new approaches to improve efficiency and meet departmental goals.

MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS

• Graduation from high school and demonstrated possession of the knowledge, skills, and abilities gained through at least two years of office assistant/secretarial experience; or an equivalent combination of training and experience.

PREFERRED QUALIFICATIONS

• Experience using billing systems such as EPIC, Patagonia Health, or CureMD Familiarity with NC Tracks, Availity, and other payer portals Certified Professional Biller (CPB), Certified Professional Coder (CPC), and/or Certified Revenue Cycle Professional (CRCP) Completion of a two-year program in health administration, business, accounting, or a related field with one year of responsible experience in billing or related work
• Experience using billing systems such as EPIC, Patagonia Health, or CureMD
• Familiarity with NC Tracks, Availity, and other payer portals
• Certified Professional Biller (CPB), Certified Professional Coder (CPC), and/or Certified Revenue Cycle Professional (CRCP)
• Completion of a two-year program in health administration, business, accounting, or a related field with one year of responsible experience in billing or related work

PHYSICAL DEMANDS

UNAVOIDABLE HAZARDS (WORK ENVIRONMENT)