Billing Specialist I
The Billing Specialist I is responsible for collecting and entering claims, post insurance, submit claims, and answer patient inquiries on accounts. Reports to the Billing Supervisor.
Essential Duties and Responsibilities
• Enters information necessary for insurance claims such as patient, insurance, and insurance ID. Insures claim information in complete and accurate.
• Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper UB04 and/or CMS-1500 form.
• Answers patient questions on patient responsible portions, copays, deductibles, write-off's, etc. resolves patient's complaints or explains why certain services are not covered.
• Follow up with insurance company on unpaid or rejected claims. Resolves issues and re-submits claims.
• Prepares appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany letter.
• Work with patient to establish payment plan for past due accounts in accordance with provider policies, as needed.
• Follows HIPAA guidelines in handling patient information.
• Provides necessary information as needed to collection agencies for delinquent or past due accounts.
• Post insurance and patient payments using medical claim billing software.
• May perform "soft" collections for patient past due accounts. This may include contacting and notifying patients via phone or mail.
• Prepares and submits secondary claims upon processing by primary insurer.
• Understand managed care authorizations and limits to coverage such as number of visits.
• Verify patient benefits eligibility and coverage as needed.
• Look up ICD10 diagnosis and CPT treatment codes from online service or using traditional coding references.
• Reviews accounts receivable aging reports and client accounts receivable balances and takes appropriate steps to obtain timely payments
• Send collection letters and statements
• Create and maintain documentation regarding collection activity
• Cross training in Registration
High School Diploma or GED required.
Medical billing experience highly preferred. Experience in billing software and electronic data submission preferred.
• Must have strong interpersonal and communication skills and be able to tactfully interface with internal and external clients (including phone and e-mail)
• Able to analyze receivables situations, and then apply creative problem-solving skills to resolve client disputes and disagreements
• Tenacity and an aptitude for timely and meaningful follow through on collection activities and initiatives
• Organized and able to manage collection activities on multiple past due accounts
• Strong attention to detail and accuracy
• Basic knowledge of invoicing, accounts receivable, collection cycles and the related accounting
• Basic knowledge with the Microsoft Office Suite of products (Outlook, Excel, Word)
Position Type : Full Time
Shift : Day
Salem Memorial District Hospital
35629 Highway 72
Salem, MO 65560