BMS INSURANCE BILLING SPECIALIST

BLOOMINGTON MEDICAL SERVICES JOB DESCRIPTION

Insurance Billing Specialist

MAIN FUNCTION:

Submits patient claims to their prospective payors, either electronic or hardcopy. Follow-up on submitted claims for payment. Coordinates with Registration Department and Case Management Department for approvals, denials and changes in billing requirements. Handles inquiries on patient accounts regarding insurance billing and accounts receivable. Follow up on Credit balances and Charging or Cash Posting Payments and adjustment errors.

RESPONSIBLE TO: System Manager, Revenue Cycle

MUST HAVE REQUIREMENTS:

High School Diploma or GED.

1 year current billing experience, preferably in a hospital setting.

Strong organizational skills.

No written disciplinary action within the last 12 months.

PREFERRED ATTRIBUTES:

Demonstrated effective oral communication skills.

• Denotes ADA Essential

• Follows Appropriate Service Standards

POSITION EXPECTATIONS:

• Reviews all rejected/denied claims in assigned work queues. Investigates denial/rejection reasons and resubmits claims as appropriate. Ensures that all accounts have complete collection notes so as to ensure steps taken to collect are documented. Escalates unpaid claims for review to department leadership as necessary.

• Downloads, edits, and transmits electronic claims.

• Attaches any necessary reports or forms to claims when applicable.

• Receives, resolves and replies to various payors and patient enquiries regarding accounts receivable.

• Makes transfers and adjustments to patient accounts to ensure accuracy of statements.

• Keeps abreast with current billing requirements for specific payors and shares changes with Registration and Quality Support Departments.

• Reviews aged accounts receivables and follows up with necessary action to obtain payment from third party payers

• Advises department leadership of any needed updates to insurance plan dictionary

• Certain billing positions Client Billing and follow up, in addition to extensive credit balance reviews and resolution.

Revised Dates: 6/24

Approved by Human Resources: