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Patient Biller

Class Specifications – H.45
Patient Biller V – 4660
Patient Biller IV – Supervisor – 4661
Patient Biller IV – 4662
Patient Biller III – 4663
Patient Biller II – 4664
Patient Biller I – 4665

June, 1992

Series Concept

Patient Billers are responsible for initial billing procedures for patient care and for subsequent actions required to assure correct, expeditious payment of bills and perform other related duties as assigned.

Incumbents apply a complete knowledge of private insurance, government programs, and uninsured patient billing procedures, as well as a knowledge of University procedures, such procedures being complex and subject to frequent revision. Billers maintain and use rate manuals and computer-generated data in initiating correct billing procedures; follow-up by telephone, personal inquiry, or statement to the proper source; review all accounts monthly; interpret carrier payments; verify accuracy of payments using knowledge of disallowances and percentage payments; and make corrections as necessary.

Class Concepts

Patient Biller V

Under general supervision, incumbents supervise Patient Billers in assigned unit; monitor and adjust workload; develop procedures; review and interpret regulations and their impact on current systems; adapt systems to meet those needs; and act as technical resource to staff.

Patient Biller IV

Under general supervision, incumbents gather service-based data and act as liaison to corresponding department representatives; act as a resource to staff; review and resolve problem/more complex accounts requiring a broad-based knowledge of all payor requirements; compile production reports and perform Patient Biller III duties. Incumbents may assume lead responsibility for lower level Patient Billers and supervisor’s duties in his/her absence OR may supervise large groups of Level I and II Billers as a primary function.

Patient Biller III

Under supervision, incumbents pursue collections on patient account balances from insurance carriers, legal representatives, or any other outside agency having inquiries/complaints related to patient accounts. Duties may also include auditing, researching, adjusting, re-billing and cross-billing accounts to follow-up on claims through denial and appeal processes; updating on-line.patient account system; use of electronic media for submission and follow-up of claims; and receiving, reviewing and collecting data on hospital/patient claims prior to billing.

Patient Biller II

Under supervision, incumbent typically audit accounts, prepare and complete third party claims for electronic/hard copy submission; identify and post payments to individual accounts; perform patient billing; balance cash accounts; identify, prepare and apply contractual allowances; initiate telephone inquires to identify payments and remittances; photocopy various billing documents; update on-line patient account system; review patient correspondence to determine if self-pay accounts may be billable; and establish liability accounts.

Patient Biller I

Under close supervision, incumbents sort, match, file, locate and retrieve billing documents and patient account files. Incumbents also perform general clerical assistance in photocopying material, paper sorting, stapling and document delivery. Incumbents may assist higher-level Patient Billers by initiating routine telephone inquiries, preparing patient payment files, assisting patients with routine procedural billing questions, and assisting in the maintenance of patient account systems. This is the entry level of the series.

The Patient Biller series specifically recognizes supervisory responsibility in two of its five levels (IV-V). Positions allocated to the supervisory titles in this series must meet the criteria for supervision as defined in the Supplemental Guidelines for Supervisory Classes (SAM 12).