Professional Billing Specialist, Anesthesia

Role Overview

• Managing all professional billing requirements
• Managing accounts receivable tasks according to standard and productivity measurements.
• Ensuring all regulatory and payor guidelines are followed.
• Coordinating payor denial and appeal follow up activities to ensure timely response from third party payors.
• Processing all payor denials, documentation requests and appeals.
• Reviewing all denial accounts for categorization and special requirements for initiating appeals.
• Communicating global payer issues with the payer relations team.
• Assisting with monitoring of the day-to-day activities related to appeal follow up and denials.
• Maintaining the healthcare tracking tool/application.
• Monitoring all Claim Edit and Denial Management work queues and lists.
• Ensuring medical records requests are completed and submitted within 48 hours.
• Tracking all denials on a database to determine the outcome.
• Collecting/analyzing, report status, metrics and trends of activity.
• Distributing reports on a routine basis to specific distribution group.
• Organizing all data and activity in a retrievable way.

Requirements

• Epic PB Resolute experience
• 3 years of related Anesthesia experience
• 5 years' experience in a Healthcare/Hospital Revenue Cycle Environment including Third Party Collection/AR Receivables
• Healthcare Revenue Cycle revenue management
• EDI Transaction sets including 837P
• Knowledge of insurance contract rates and terms
• Understanding of Registration and Collections
• Understanding of Government and Managed Care billing, coverage and payment rules
• Ability to comprehend payor 835 and paper EOB responses
• Understanding of CCI edits, CPT, HCPCS, ICD-10 and Revenue Codes
• Intermediate Excel skills
• Excellent computer skills, especially spreadsheet and database applications.
• Knowledge of managed care patient financial systems and of the specific billing and payment standards utilized for services provided within a hospital setting.
• Thorough understanding of managed care payment methodologies and the principles of managed care.
• Certification in Epic PB Resolute
• or agree to obtain certification within 12 months after hire
• Bachelor’s Degree or equivalent combination of education and experience

Benefits

• All employees are eligible for medical coverage on their first day!
• Eligible for a 403(b) and Roth 403 (b) Retirement Saving Plan with matching contributions of up to 6% after one year of service.
• Paid time off
• Life insurance
• Short term and long-term disability
• Flexible Spending Account (FSA) plans
• Health Savings Account (HSA) if a High Deductible Health Plan (HDHP) is elected.
• Additional benefits include tuition reimbursement
• Home & auto insurance
• Hospitalization
• Critical illness insurance
• Pet insurance
• Employee and dependents coverage in accordance with the plans.