ADV PATIENT REPRESENTATIVE

Newport Hospital and Health Services; Newport Township (OH); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

Retirement match

Life and disability insurance

AFLAC

Flexible Spending Account

Employee Assistance Program

Bonus program

Tuition reimbursement

Job summary

Newport Hospital & Health Services seeks a skilled medical billing specialist to manage claims submission and denial resolution. You will review charges, prepare documentation for appeals, and liaise with patients and insurers while ensuring confidentiality and compliance.

Responsibilities include monitoring EOBs, addressing aging balances, and applying Medicare, Medicaid, and other payer guidelines to maximize accurate reimbursements.

Qualifications

• High School diploma or equivalent.
• AAHAM CRCS-I certification or related billing certification/degree.
• 3 years medical billing experience required.
• Knowledge of Medicare/Medicaid programs and patient benefits.

Responsibilities

• Submit claims to third-party payers and verify accuracy of charges.
• Review denied or incomplete bills and submit appeals with documentation.
• Research and resolve billing issues with patients, providers and insurers.
• Monitor insurance EOBs for payments and accuracy; follow up on aging balances.
• Submit claims electronically or by paper and apply CCI edits and modifiers.

Skills

Medical billing experience

Customer communication

Attention to detail

3 years medical billing experience

Medicare/Medicaid knowledge

Education

High school diploma or equivalent

AAHAM CRCS-I certification

Job description

Newport Hospital & Health Services
714 W. Pine St
Newport, WA 99156, USA

Description

Primary Scheduled Hours: Days, 80 hours per pay period

Job Summary:

Responsible for medical billing functions and submission of claims to third- party payers for payment. Reviews claims to verify accuracy and completeness of charges; researches denied or incomplete bills; submits secondary claims, claim adjustments, and corrected claims as needed; submits letters of appeal with proper documentation to insurance carriers. Works closely with district departments, providing updates regarding codes, benefit limits, or changes for patients' health insurance, including state and federal programs. Interacts with patients regarding medical benefits, processes patient payments, and resolves minor billing complaints. Monitors insurance EOB payments for amount paid and accuracy.

Essential Job Functions:

• Interacts daily with patients/families regarding billing problems and insurance issues.
• Investigates and follows up on questions/issues to resolve concerns accurately and timely, communicating information to staff as needed.
• Maintains working knowledge of services offered and applicable insurance guidelines regarding eligibility and reimbursement.
• Assists patients and insurance companies with billing issues, ensuring confidentiality of patient records.
• Compiles hospital claims, completes appropriate forms, and submits claims to proper agencies/insurance companies electronically and/or by paper.
• Recognizes outstanding account/insurance balances (aging) and determines appropriate action.
• Applies knowledge of claim submission, including CCI edits, modifiers, medical necessity rejects, and late charges for Medicare, Medicaid, and other government and commercial carriers.
• Prepares credit balance documentation for insurance carrier overpayments.

Education Background and Experience Requirements

High School graduate or equivalent, or equivalent relevant experience.

Required Licensure / Certification

AAHAM Certified Revenue Cycle Specialist, Institutional (CRCS-I) certification; or other related billing certification or degree.

Required Experience (Attested)

Three (3) years medical billing experience required.

Preferred Qualifications

Comprehensive knowledge of claim submission for multiple payers; in-depth understanding of Medicare and Medicaid programs and patient benefits.

Professional Requirements:

• Maintain regulatory requirements
• Report to work on time and as scheduled; complete work within designated timelines.
• Demonstrates the ability to adhere to the mission, ethics and goals of the District.
• Demonstrates the ability to communicate with patients, guests and staff in a courteous, respectful and helpful manner.

Compensation/How We Care For You:

Successful candidates typically begin between the beginning and midpoint of the compensation range dependent on qualifications/experience and receive compensation in increments increases annually.

• Retirement with a 6% dollar for dollar employer match
• Life and Disability Insurance
• AFLAC
• Flexible Spending Account
• Employee Assistance Program
• Bonus, if eligible upon Board approval
• Tuition Reimbursement and Student Loan Repayment Opportunities

Newport Hospital & Health Services (NHHS) is committed to a diverse and inclusive workplace. NHHS is an equal opportunity employer and does not discriminate based on race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status.

NHHS employs only U.S. citizens and lawfully authorized non-U.S. citizens. All new employees must show employment eligibility verification as required by the U.S. Citizenship and Immigration Services.

NHHS is committed to providing access and reasonable accommodation in its services, programs, activities, education and employment for individuals with disabilities.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.