SENIOR PATIENT RELATIONS REPRESENTATIVE - 40000958

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**THIS IS A REPOST, ALL APPLICANTS ARE STILL BEING CONSIDERED**

GENERAL DESCRIPTION:

This position supports the billing unit by performing accurate and timely billing and coding of medical and dental claims for all clinical programs in the local health department. Under the direction of the Billing Operations Supervisor, the employee follows established procedures, ensures compliance with HIPAA and state and federal regulations, and helps maintain correct documentation for efficient claim processing. Responsibilities include preparing and verifying claims, correcting errors, responding to payer requests, and assisting with billing needs for programs such as Family Planning, STD, Tuberculosis, Immunization, Refugee Health, Maternal Health, Nutrition, and Dental Services.  

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

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.

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

PHYSICAL DEMANDS:

Physical demands refer to the requirements for physical exertion and coordination of limb and body movement.

• • Performs sedentary work that involves walking or standing some of the time and involves exerting up to 10 pounds of force on a regular and recurring basis or sustained keyboard operations.

UNAVOIDABLE HAZARDS (WORK ENVIRONMENT):

Unavoidable hazards refer to the job conditions that may lead to injury or health hazards even though precautions have been taken.

• • None

 STANDARD CLAUSES:

May be required to work nights, weekends, holidays and emergencies (man-made or natural) to meet the business needs of Durham County.

This job description is not designed to cover or contain a comprehensive listing of essential functions and responsibilities that are required of an employee for this job. Other duties, responsibilities, and activities may change or be assigned at any time with or without notice.

 ESSENTIAL SAFETY FUNCTIONS:

It is the responsibility of each employee to comply with established policies, procedures and safe work practices. Each employee must follow safety training and instructions provided by their supervisor. Each employee must also properly wear and maintain all personal protective equipment required for their job. Finally, each employee must immediately report any unsafe work practices or unsafe conditions as well as any on-the-job injury or illnesses.

Every manager/supervisor is responsible for enforcing all safety rules and regulations. In addition, they are responsible for ensuring that a safe work environment is maintained, safe work practices are followed and employees are properly trained.

To further the mission of the Durham County Department of Public Health (DCoDPH) to partner with our community to advance health equity, protect the environment, and promote health and wellness for all, DCoDPH is implementing the employee vaccination and tuberculosis screening policies. All DCoDPH employees are considered healthcare personnel (HCP) working in a health care setting with the potential for exposure to patients and/or infectious materials and, therefore, are required to comply and provide documented proof of the following:

• Measles, Mumps & Rubella (MMR) vaccination/immunity 
• Varicella-Zoster Virus (Chicken Pox) vaccination/immunity 
• Tdap (Tetanus, Diphtheria, Pertussis)
• Tuberculosis (TB) baseline screening within the last twelve (12) months prior to employment
• Hepatitis B vaccination/immunity – only required for DCoDPH employees with potential Bloodborne Pathogen (BBP) exposures.

Identified DCoDPH HCP with potential Bloodborne Pathogen (BBP) exposure have an additional requirement for the Hepatitis B vaccination. Required vaccination, serological testing to determine immunity, and baseline tuberculosis screening are available for all Public Health employees who elect to become DCoDPH patients upon request and at no cost.

Proof of vaccination and tuberculosis screening must be provided to Human Resources within seven (7) business days prior to the date of employment.

AMERICANS WITH DISABILITIES ACT COMPLIANCE:

Durham County is an Equal Opportunity Employer. ADA requires Durham County to provide reasonable accommodations to qualified persons with disabilities. Prospective and current employees are encouraged to discuss ADA accommodations with management. 

BACKGROUND CHECK STATEMENT:

This position may be subject to a background check, which could include, but is not limited to, criminal history (employment-related and/or SBI fingerprint-based), credit history, motor vehicle records, educational verification, and checks of the sexual offender registry, depending on the specific requirements of the role. A conviction record does not automatically disqualify an applicant from employment consideration, unless otherwise required by applicable state law.