Senior Billing Specialist

1 month ago


Philadelphia, Pennsylvania, United States Jefferson Health Full time
Job Summary

We are seeking a highly skilled and experienced Billing Operations Manager to join our team at Jefferson Health. This is a critical role that requires a strong understanding of complex billing, revenue cycle management, and clinical operations.

Key Responsibilities
  • Manage all aspects of billing operations, including charge capture, billing, and revenue cycle management.
  • Ensure accurate and timely billing of all hospital and professional charges.
  • Review and audit billing to ensure compliance with federal regulations and policy & procedures.
  • Work closely with physicians and staff to obtain information required for initial claim submission and follow-up on edits, denials, and rejections.
  • Manage billing denials, follow up on each denial to determine the cause, and eliminate the causes of denials to collect the maximum on each patient account as rapidly as possible.
  • Consult with physicians and nurse managers for clarifications of clinical data when encountering conflicting or ambiguous information and/or missing documentation.
  • Interact with co-workers, visitors, and other staff consistent with the values of Jefferson.
  • Process billing of daily code captures, including coordination of the daily operations and workflow processes while managing billing edits/denials.
  • Responsible for working Quality Assurance Check Lists implemented by Physics and Dosimetry staff to ensure the accurate collection and capture of charges.
  • Adjust work assignments as necessary to keep billing lag to a minimum.
  • Daily Charge reconciliation.
  • Keep up-to-date with Mosaiq/EMR system upgrades that affect workflows related to billing and documentation.
  • Respond to telephone inquiries from patients and insurance companies regarding billing, coverage criteria, coordination of benefits, and subscriber eligibility.
  • Assist Director with monthly Collection Report.
  • Assist Director with developing and implementing procedures to streamline billing process and improve efficiency of process.
  • Cover other positions within the department when needed.
Requirements
  • High School diploma or GED required. Associates degree preferred.
  • 5 or more years of experience in the area of billing operations.
  • Word, Excel, NaviNet, EviCore, etc. Must have knowledge of CPT and ICD-10 coding.
  • Up-to-date knowledge of third-party rules and regulations.
  • Knowledge of medical terminology.
About Jefferson

Jefferson Health is a nationally ranked, not-for-profit health care system that serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability, or any other protected group or status.



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