Healthcare Billing Specialist

Essential Duties & Responsibilities: 
 
- Utilizes various hospital/physician systems to verify patient, billing and claim information for accuracy. 
- Performs compliant primary/secondary, tertiary and re-bill billing functions, including electronic, paper and portal submission to government and/or commercial payers. 
- Edits claims to meet and satisfy billing compliance guidelines for electronic and hardcopy submission. 
- Responds timely to emails and telephone messages, as appropriate. 
- Communicates issues to management, including payer, system or escalated account issues.
- Participates and attends meetings and training seminars, as requested.  
- Adheres to professional standards, hospital policies and procedures, federal, state, and local requirements, and JCAHO standards. 
- Enhances billing department and hospital reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments. 
- Updates patient demographics/insurance information in appropriate systems. 
- Monitors claims for missing information, authorization and control numbers (ICN//DCN). 
- Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems. 
- Secures needed medical documentation required or requested by third party insurance carriers. 
- Maintains and respects the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure. 

In addition: 
- Utilize provider billing manuals to obtain billing guidelines and requirements 
- Import verification and escalation of import/export files 
- Special Handling billing included not limited to interim bills, overlap review, redistribution of money for correct claim creation 
- Resolve and research billing Rejections 
 
Minimum Requirements & Competencies:  

- 2+ years of medical collections/billing experience 
- Intermediate knowledge of ICD-10, CPT, HCPCS and NCCI 
- Intermediate knowledge of third party billing guidelines 
- Intermediate knowledge of billing claim forms(UB04/1500) 
- Intermediate knowledge of payor contracts 
- Working Knowledge of Microsoft Word and Excel 
- Intermediate working knowledge of health information systems (i.e. EMR, Claim Scrubbers, Patient Accounting Systems, etc.) 

Preferred Requirements & Competencies:  
- Working knowledge of one or more of the following Patient accounting systems -  EPIC, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts, or Paragon 
- Working knowledge of DDE Medicare claim system 
- Knowledge of government rules and regulations