Billing Specialist

Position Title: Billing Specialist

Department: Business Office

Supervisor’s Title: Revenue Cycle Manager

Position Summary: Process primary and secondary claims electronically or paper format with complete information to reduce denials and maximize reimbursement. Works claim scrubber edits, denials, and accounts receivable reports. Payment posting. Files appeals. Communicates effectively with patients regarding accounts and insurance issues. Reconciles patient accounts prepares adjustments for review.

Principal Functions and Responsibilities:

1. Follows established departmental policies and procedures, objectives, and Quality Improvement and Safety programs.
2. Responsible for payer specific caseload(s) i.e. Medicaid, Commercial, etc.
3. Interprets and explains to patients/guarantors their associated charges, services, and hospital policies regarding payment both insurance and private responsibility.
4. Serves as relief for Admitting Clerk and Emergency Registration when needed.
5. Electronically bills primary payers. Files secondary claims. Reconstructs claims when necessary or insurance information becomes available.
6. Makes written and/or verbal inquires to payers to reconcile patient accounts.
7. Works denied claims, A/R reports, and corrections in a timely manner to assure maximum reimbursement.
8. Works accounts with payer credits and prepares information for Business Office Manager to review.
9. Prepares accounts for adjustments i.e. insurance, timeliness issues.
10. Enhances professional growth and development through participation in educational programs, current literature, in-service meeting, and workshops.
11. Attends meetings as required.
12. Maintain positive and effective relations with co-workers, other departments, patients and visitors.
13. Identify and communicate to Lead Biller opportunities for system or process improvement.
14. Perform other duties as assigned.
15. On occasion may be required to work overtime or weekend shifts.
16. Maintain confidentiality in matters relating to patient/family.
17. Provide information to patients and families to reduce anxiety and convey an attitude of acceptance, sensitivity and caring.
18. Maintain professional relationships and convey relevant information to other members of the healthcare team within the facility and any applicable referral agencies.

1. Minimum Education: High School diploma or equivalent.
2. Minimum Experience and Skills: At least 1-year billing experience in a hospital or clinic setting and general knowledge and understanding in the following areas:
3. CPT, ICD-9 and ICD-10 codes, revenue codes
4. Follow up for all insurance payers
5. Knowledge of UB and HCFA billing
6. Critical Access Hospital (CAH) and Rural Health Clinic
7. Effective communications with co-workers, insurance companies, etc.

Working Conditions:

1. Works in office setting and with patients. Potential exposure to patient elements in general.
2. Blood Borne Pathogens – potential exposure to blood, body fluids or tissues.
3. Physical Requirement: Sitting and working at a computer keyboard, walking, lifting, reaching, hand eye coordination, speaking.