Insurance Biller - Hybrid

Billing Specialist

This position is responsible for timely and accurate billing of assigned accounts to a variety of payors using the computerized patient accounting systems. Responsibilities also include staying current with UB-04 and HCFA-1500 billing requirements, HIPAA Regulations, Payor Regulations, and Payor Contractual Agreements to ensure proper billing and compliance. This position is responsible for communication to supervisor/manager as to identify issues associated with charges, billing, etc. so billing systems are programmed accurately for billing. Demonstrate respect, dignity, kindness, and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background.

Billing Responsibilities:

• Review bills and related information for accuracy and reasonableness of charges
• Audit claims for overlap (charges, dates, coding, condition codes, modifiers, discharge status) and resolves issues with medical records and revenue department heads. (as applicable)
• Work Specific Reports (as applicable)
• Submit bills to payers electronically if possible, otherwise paper
• Proficient in Commercial/Medicare/Medicaid Government regulations and reimbursement policies
• Proficient in third party contractual agreements and regulations to apply requirements for accurate billing and to make recommendations for system changes as needed
• Stay current with third party contractual arrangements and regulations (Medicare, Medicaid, Champus, managed care, etc.) to apply requirements for accurate billing and to make recommendations for system changes as needed.
• Compute required adjustments to bills, balances to support, and inputs debits/credits to billing system to appropriate codes to ensure accurate billing.
• Follow up on unbilled claims pending Medical Records coding, claim forms, etc. in order to bill on a timely basis.
• Take appropriate action to resolve claims. Execute any, and all, steps to resolve unpaid, including but not limited to; rebill of claim
• Perform due diligence on all collection efforts
• Assist other associates when necessary, as determined by manager, work with staff to identify and resolve issues and develop standard
• Elevate serious barriers to claim resolution to appropriate management
• Demonstrate adequate, appropriate, and professional levels of communication with insurance company representatives, team members, supervisors, and managers
• Record approved detailed note in the billing system
• Ensure expected reimbursement is secured with knowledge of billing system Expected Reimbursement data or payor contract
• Meets productivity and quality standards on a weekly basis
• Understand and adhere to the concepts of stratification
• Demonstrate ability to work with high volume edits
• Ensure timely turnaround of internal requests (EOB's, medical records)
• Seek opportunity for training and informs supervisor of all training needs

Other:

• Complete special projects & tasks by the established time frame which can include organizing workload and/or associates for successful account resolution: proactively notify supervisor of any barriers that prohibit billing and/or payment of claims
• Assume duties of supervisor or lead as needed. Assist co-worker in problem solving, with reports, meetings, etc.
• Complete other billing tasks and duties as assigned by manager
• Execute training of contract staff (internal and external)
• Act as a preceptor for new employees and as a resource within the department

Communication/Trending:

• Trends weekly productivity, Billing CFB, Open AR
• Edit WQs (Securing required data necessary for billing.)
• Attends weekly billing staff meetings
• Identifies payer & billing issues
• Participates in a positive & constructive manner
• Respond to internal and external customer calls or concerns.

Continuing Education & Training:

• Seeks opportunity for training & informs supervisor of all training needs.
• Attends Seminars and workshops as assigned by manager, to obtain billing and/or follow up information related to specific payers.
• Perform other duties as assigned.

Education, Credentials, Licenses:

• High School diploma or GED

Specialized Knowledge:

• PC Skills, including Word and Excel
• Detail Oriented
• Customer Service Skills
• Excellent Communication Skills
• Billing or Follow Up experience

Kind and Length of Experience:

• One year's experience in billing or follow-up activities
• Experience in customer service, billing or related field.

FLSA Status: Non-Exempt

Right Career. Right Here. If you're looking for the right careers in healthcare, the right place to be is at St. Elizabeth. Join us, and you'll take pride in the level of care we offer our community.