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 :

Communication / Trending :

Continuing Education & Training :

Education, Credentials, Licenses :

Specialized Knowledge :

Kind and Length of Experience :

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.