Business office representative

General Purpose: The Business Office Representative is responsible for supporting all aspects of the hospital revenue cycle, including patient financial services, insurance claims processing, reimbursement follow-up, collections, and customer service. This position works collaboratively with patients, providers, clinical departments, and insurance payers to ensure timely claim submission, accurate reimbursement, and resolution of patient accounts. The Business Office Representative maintains a thorough understanding of Critical Access Hospital (CAH) billing and reimbursement guidelines while providing exceptional customer service and maintaining compliance with federal, state, and payer regulations.

Essential Duties/Responsibilities:

• Answer patient billing questions and explain patient financial responsibility.
• Make first statement and collection calls on outstanding patient balances.
• Establish and maintain patient payment plans according to hospital policy.
• Discuss available payment options, including Patient Financial Assistance and Medicaid eligibility.
• Assist patients in completing Financial Assistance applications and obtaining required documentation.
• Collect and process patient payments.
• Prepare and reconcile daily deposits according to hospital cash handling policies.
• Update and verify patient demographic and insurance information within Athenahealth.
• Document all patient communications and account activity in Athenahealth.
• Work assigned claim worklists within Athenahealth.
• Review, research, and resolve claim edits, claim holds, denials, and rejected claims.
• Research patient accounts to ensure balances are accurate before collection activity.
• Resolve billing discrepancies through collaboration with ER Registration, Coding, and Clinical Departments.
• Process appropriate account adjustments in accordance with hospital policy.
• Assist with credit balance resolution.
• Recommend accounts for outside collection agency placement according to hospital policy.
• Maintain thorough documentation of all account activity within Athenahealth.
• Follow up on all contract accounts.
• Coordinate with the remote Business Office to resolve claim, billing, reimbursement, and account issues.
• Submit authorizations for inpatient, outpatient and swing bed services.
• Maintain Extended Care Facility (ECF) billing records and supporting documentation.
• Work the refund worklist and process approved patient and insurance refunds in accordance with hospital policy.

Other Duties/Responsibilities:

Performs other duties as assigned by the manager. Identifies organization problems and opportunities for improvement and brings solutions and suggestions to supervisor’s attention.

Experience:

3 - 5 years of healthcare revenue cycle experience is required, with Critical Access Hospital (CAH) business office experience strongly preferred. Experience should include healthcare billing, patient financial services, insurance claims processing, collections, and utilization review/authorizations.

Knowledge, Skills, and Ability:

Must be able to read, write, and understand English and communicate effectively with patients, staff, providers, insurance representatives, and other healthcare professionals. Requires a strong knowledge of hospital revenue cycle operations, including Critical Access Hospital (CAH) reimbursement principles, Medicare, Medicaid, Medicare Advantage, commercial insurance, Workers' Compensation billing, claim processing, denial management, patient collections, and financial counseling. Must be proficient in Athena Practice Management and Electronic Health Record (EHR) systems, Microsoft Office applications (including Excel), payer portals, and electronic remittance advice (ERA). The ability to accurately interpret Explanation of Benefits (EOBs), determine payer reimbursement, contractual adjustments, denials, and patient responsibility is essential. Knowledge of the Wyoming Medicaid application process, including assisting patients with eligibility and application completion, is highly recommended. Must be able to obtain and track inpatient, outpatient, and swing bed authorizations through payer portals. Strong customer service, organizational, analytical, and problem-solving skills are required, along with the ability to manage multiple priorities, meet deadlines, maintain confidentiality, and comply with hospital policies and HIPAA regulations.

Working Environment:

Working in a healthcare setting requires a high level of confidentiality, accuracy, and professionalism. This position involves frequent patient interaction by phone and in person, coordination with clinical staff, extended periods of computer and phone use, and adherence to hospital policies and patient-centered care standards.

Monday-Friday 8:00am-5:00pm