Medical Billing Specialist I

2 weeks ago

Pensacola, Florida, United States Baptist Health Care Full time
Job Overview

The Medical Billing Specialist is tasked with essential duties in the reconciliation of Accounts Receivables. This role encompasses a variety of responsibilities including, but not limited to: reviewing, amending, and consistently updating Patient Health Information to guarantee precise insurance billing, payment, and follow-up; electronically submitting claims to payers using the designated software; examining rejected claims within the billing system to ensure they are corrected and resubmitted accurately to prevent denials; applying suitable contractual and self-pay adjustments; addressing inquiries from patients and insurance carriers; liaising with physician offices when necessary to secure authorizations or inform them of medically unnecessary diagnostic orders; utilizing online systems provided by various payers to confirm eligibility and benefits while checking claim statuses; maintaining thorough and consistent documentation on all accounts processed; implementing sound account management principles to ensure accurate billing; identifying non-payment trends by payer and alerting management; working towards productivity goals set by management for the daily submission of validated claims; making necessary account corrections to facilitate prompt payment of claims, regardless of departmental responsibilities; preparing and mailing medical records and itemized statements for payers requiring paper submissions; and, if needed, contacting patients or employers to verify health insurance or worker's compensation details to ensure timely and accurate claim submissions. The role demands a high level of professionalism and effective communication when collaborating with other departments within the business office or revenue cycle to ensure timely and accurate billing.

Key Responsibilities
  • Manage the billing process for patient accounts, including reviewing, correcting, and consistently updating health insurance claims to ensure prompt payment and follow-up.
  • Address inquiries from patients and insurance carriers regarding billing within the revenue cycle.
  • Utilize online systems from multiple payers to verify eligibility and benefits, and check claim statuses appropriately.
  • Engage with payers via telephone to investigate denial trends in billing, ensuring claims are submitted accurately.
  • Maintain consistent and accurate documentation on accounts processed within the patient accounting systems.
  • Review memos on accounts within patient accounting systems for all reprinted or rebilled claims to ensure necessary updates are made prior to submission.
  • Identify non-payment trends by payer and inform systems coordinators and management to adjust billing practices and reduce A/R days.
Qualifications

Minimum Education
  • High School Diploma or Equivalent Required
Minimum Work Experience
  • 6 months of relevant experience in the revenue cycle (patient access, financial assistance, insurance billing, collections, reimbursement, customer service, payer contracting, or coding) Required
  • Experience in healthcare insurance billing Preferred
About Baptist Health Care

Baptist Health Care is a not-for-profit healthcare organization dedicated to enhancing the quality of life for individuals and communities in northwest Florida and south Alabama. The organization encompasses three hospitals, four medical parks, the Andrews Institute for Orthopaedic & Sports Medicine, and a comprehensive network of primary and specialty care providers. With a workforce exceeding 4,000 team members, Baptist Health Care stands as one of the largest non-governmental employers in northwest Florida.

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