Billing Representative - Level 1 (53152)

Performance Home Medical has been a leader in providing quality products and services since 1995.

At Performance Home Medical, our patients come first. Using the latest technology and best clinical support, we help our patients take control of their conditions and live longer and healthier.

Position Summary: The Billing Representative (Level 1 – Medicare & Private Insurance, Insurance Changes) plays a critical role in ensuring the accurate and timely processing of patient billing and collections.  This position is responsible for managing documentation, resolving denials, auditing accounts, and maintaining compliance with insurance, state, and federal regulations. The ideal candidate brings a strong understanding of payer guidelines, HIPAA regulations, and company policies.  In addition, they manage designated tasks and reportings to support a seamless reimbursement process. Additionally, the Billing Representative responds to billing inquiries, adjust balances, and assist with internal and external audits to uphold performance standards and key metrics.

Job Duties and Responsibilities include the following. Other duties may be assigned.

• Answer billing and collection questions for patients, referral sources, and coworkers.
• Assist PHM’s billing and collections services with denials.
• Maintain and request documentation required to meet continued billing requirements.
• Audit account for accuracy and adjust balances as needed.
• Maintain and request on-going authorizations when required to assure flow of revenue.
• Maintain a high level of knowledge and understanding of the insurance guidelines for all payers within the PHM designated patient base.
• Maintain a current knowledge of HIPAA privacy laws and regulations.
• Work designated tasks and reports to maintain all avenues of reimbursement flow smoothly. 
• Perform internal and external audits to ensure insurance plan guidelines as well as State and Federal Regulations were met.
• Meet key performance metrics. 
• Follow insurance plan guidelines as well as State and Federal Regulations.
• Complies with all applicable company policies and procedures.
• Monitors and records client, physician, and referral source communications. Notifies appropriate personnel if a service or response, within the scope of their responsibilities, is required.
• Assists with the implementation of performance improvement program to meet company, state, federal, and accreditation standards.
• Always maintains patient confidentiality according to company policy.

This role is part of the Billing Representative job family, which includes levels 1-5. 

Advancement is based on demonstrated competencies and business needs.

• Level 1 – Medicare & Private Insurance, Insurance Changes
• Level 2 – Patient Notes, Refunds
• Level 3 – Billing Corrections, Stops
• Level 4 – Vendor Kickbacks
• Level 5 – Internal & External Audits

Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Education/Experience: Associate degree (A.A.) or equivalent from two-year college or technical school; or six months to one-year related experience and/or training; or equivalent combination of education and experience.

• Knowledge of home medical equipment
• Basic knowledge of medical terminology/ICD codes preferred.
• Type at least 40 words per minute with no errors
• Organizational skills

Language Ability: Read and interpret complex documents. Respond effectively to sensitive inquiries. 

Mathematical Ability: Addition, Subtraction, Multiplication, and Division. Work with whole numbers, decimals, and fractions. Knows times tables and how to calculate change, prices, or totals.

Reasoning Ability: Apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Deal with problems involving a few concrete variables in standardized situations.

Computer Skills: Fluency in Microsoft Office (Word, Outlook, Chrome, Internet Explorer, SharePoint)

Certificates and Licenses: N/A

Travel Requirements: Traveling as needed within region/territory. Have reliable means of transportation. Meet requirements of our Motor Vehicle policy.

Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually unpredictable.

Physical Demands:

While performing the duties of this Job, the employee is regularly required to sit; use hands to type finger, handle, or feel. The employee is frequently required to stand and walk. The employee is occasionally required to reach with hands and arms; climb or balance and stoop, kneel, crouch, or crawl. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 20 pounds.

The above job description is not intended to be an all-inclusive list of duties and standards of the position and can be modified as needed. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor.

All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship.