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Billing Specialist-Commercial
Work Status Details : Full Time | 80.00 Hours Every Two Weeks
Exempt from Overtime : Non-Exempt
Shift Details : M-F 8a-4:30p
Department : Patient Financial Services Admin | Reports To: Manager-Patient Financial Services-Commerical
The mission of Faith Regional Health Services is to serve Christ by providing all people with exemplary medical services in an environment of love and care.
Summary:
A Billing Specialist will utilize the current Electronic Health Record (EHR) software to perform billing functions for both technical and professional services and will be responsible for timely follow-up of unpaid claims and appealing denied claims. Individuals will research current billing regulations, policies, and procedures to ensure compliant billing practices while maximizing reimbursement for services. A Billing Specialist will analyze payment variances through thorough research and work with payers to resolve the variances. Collaborate with various clinical and non-clinical departments to ensure accuracy of billing and communicate identified trends.
The listing of job duties contained in this job description is not all inclusive. Duties may be added or subtracted at any time due to the needs of the organization.
Responsibilities:
- Maintain a thorough understanding of current billing regulations, policies, and procedures for assigned payers. Utilizing current EHR software, clear claim edits, DNB’s, and Stop Bill’s in a timely manner to expedite the billing process. Ensure claims are billed to the correct primary, secondary, and tertiary payers in accordance with standard Coordination of Benefits guidelines. Process corrected claims as necessary according to organizational policies/procedures and CMS regulations.
- Follow-up on unpaid claims in a timely manner by accessing payer websites and calling provider services. Investigate the reason for non-payment and determine the next action step needed to expedite payment of claims. Provide detailed bills and medical records as requested by the payer to prevent denials and delayed processing of claims.
- Review and interpret Explanation of Benefits (EOB’s) and Electronic Remittance Advice (ERA’s). Research remark and denial codes sent by payers and take appropriate action to resolve claims. Review payment variances for assigned payers. Determine if the payer processed the claim correctly. Request payer to reprocess claims when payment errors are identified.
- Appeal denied claims by making corrections to claims, providing medical records and/or detailed bills, writing appeal letters with justification for payment, and completing other actions as directed by your manager.
- Research credit balances on accounts. Make adjustments as needed or process refunds to resolve credit balances.
- Maintain understanding of payer methodologies, fee schedules, and insurance contracts.
- Follow standard processes outlined by leadership to ensure consistency and reduce duplication of work.
- Identify and track payer and processes issues on departmental log. Assist in resolving issues by researching and proposing solutions.
- Communicate with patients and family members in compliance with HIPAA regulations to answer questions and resolve billing concerns.
Hours will be dependent on patient census and workload. Ability and willingness to work a flexible schedule, to include after-hours and weekends as necessary.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Other information:
Job Requirements:
The requirements listed below must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required.
EDUCATION:
GED or High School Diploma preferred.
EDUCATION FIELD OF STUDY:
Medical Billing/Reimbursement Program preferred.
EXPERIENCE:
Previous healthcare experience preferred.
One-year customer service experience, insurance claims submission/processing, or related field required.
SKILLS (If Applicable):
Language Skills – Ability to read, write, speak, and understand the English language required.
Computer Skills required.
Knowledge of Microsoft Office (Word/Excel) preferred.
Faith Regional Health Services is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
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