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Healthcare Billing Specialist

2 months ago


Chicago, Illinois, United States Insight Hospital and Medical Center Full time

Position Overview:


We are looking for a dedicated and detail-oriented individual to join our team as a Healthcare Billing Specialist. This role involves managing the daily billing processes and follow-up tasks related to facility claims across various locations and specialties.

The Healthcare Billing Specialist will be responsible for reviewing coding accuracy, addressing and correcting front-end rejections from the clearinghouse, and analyzing rejections from third-party payers. This position also requires monitoring aged accounts receivables, identifying areas of concern by age, category, payer, provider specialty, and facility to ensure timely resolution of claim issues and resubmissions.

Our ideal candidate will demonstrate the ability to manage multiple responsibilities while maintaining professionalism and exceptional communication skills at all times.


Key Responsibilities:
Conduct timely reviews of coding and correct front-end rejections for resubmission.
Assist in the uploading of daily 837 files and monitor unbilled accounts.
Reprocess rejections and file appeals for claim denials to maximize reimbursement for services rendered.
Engage with insurance companies regarding outstanding balances.

Determine necessary actions for resubmission, verify eligibility, ensure proper authorization is on file, and check claim status on payer websites to resolve account balances effectively.

Contact patients for updated insurance information as needed.
Monitor and follow up on the Aged Trial Balance Report, identifying potential cash delay concerns.
Resolve issues with third-party payers.
Communicate internal and external issues that may lead to cash delays promptly.
Respond to patient inquiries and provide timely assistance.

Ensure patient account billing information and balances are current; make necessary adjustments in the system and document all activities for audit purposes.

Other duties as assigned.

Qualifications:
Eligibility to work for any employer in the U.S.
A high school diploma, GED, or equivalent is required; an Associate's or Bachelor's Degree in Business, Healthcare, or a related field is preferred.

At least 3 years of experience in Coding/Billing follow-up within revenue cycle functions for a large multi-specialty physician office or hospital setting is preferred.

Experience in billing and coding in areas such as Neurosurgery, Orthopedic, Anesthesia, and In-patient is advantageous.
Preferred certifications include Certified Professional Biller (CPB), Certified Professional Coder (CPC) through AAPC, or Certified Revenue Cycle Specialist (CRCS) through AAHAM.
Familiarity with eCare CMS is a plus.

Understanding of medical billing principles, including verification, authorization, charge posting, procedures, diagnosis, medical necessity, and knowledge of federal and state regulations and billing rules.

Knowledge of CPT, HCPCS CCI, MUE, ICD-10, NCD, informational and payment modifiers is essential.
Experience with commercial billing procedures across various payer systems.
Proficiency in Outlook, G-suite, Gmail, and Google Docs (Word, Excel).
Strong verbal and written communication skills in English to ensure safe and effective patient care and meet documentation standards.
Commitment to fostering a positive work environment, even in fast-paced and changing circumstances.
Able to thrive in a high-pressure environment while maintaining a positive attitude.
Willingness to engage in goal-setting and educational opportunities for professional growth.
Ability to work compassionately with patients and colleagues to provide exceptional patient care.
Demonstrates enthusiasm, respect, and flexibility to positively impact the workplace.
Detail-oriented, conscientious, and committed to precision in work outcomes.
Ability to perform tasks with a high level of accuracy.
Friendly, empathetic, and respectful demeanor.
Reliable in work performance, punctuality, and attendance.
Ability to relate to and work effectively with a diverse population.