Utilize various hospital/physician systems to verify patient, billing and claim information for accuracy
Perform compliant primary/secondary, tertiary and rebill billing functions which can include electronic, paper and portal submission to payers
Edit claims to meet and satisfy billing compliance guidelines for electronic and hardcopy submission
Respond timely to emails and telephone messages as appropriate
Communicate issues to management, including payer, system or escalated account issues
Participate and attend meetings as requested, training seminars and in-services to develop job knowledge
Serves and protects the hospital community by adhering to professional standards, hospital policies and procedures, federal, state, and local requirements, and JCAHO standards
Enhance billing department and hospital reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments
Update patient demographics/insurance information in appropriate systems
Monitor claims for missing information, authorization and control numbers(ICN//DCN)
Follow guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems
Secure needed medical documentation required or requested by third party insurance carriers
Maintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure
Perform other related duties as required

High School Diploma or GED
At least one year of experience in healthcare insurance billing, working with or for a hospital/hospital system, working directly with government or commercial payers
Experience identifying billing errors and resubmitting claims as well as following up on payment errors, low reimbursement and denials
Experience reading and utilizing EOB, 1500 and UB-O4 Forms
Knowledge of CD-10, CPT, HCPCS and NCC
Ability to utilize third-party billing guidelines
A minimum of 6 months experience of billing claim forms (UB04/1500)
Understanding payor contracts and the ability to read and interpret them
Basic working knowledge of health information systems (i.e. EMR, Claim Scrubbers, Patient Accounting Systems, etc.)
Knowledge of accounts receivable practices, medical business office procedures, coordination of benefit rules and denial overturns and third-party payer billing and reimbursement procedures and practices
Demonstrated ability to navigate Internet Explorer and Microsoft Office, including the ability to input and sort data in Microsoft Excel and use company email and calendar tools
Demonstrated success working both individually and in a team environment
Demonstrated experience communicating effectively with payers, understanding complex information and accurately documenting the encounter
Demonstrated ability to meet performance objectives.

Billing Specialist

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