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Claims Processing and Revenue Cycle Specialist
2 months ago
Why Choose Mount Nittany Health?
At Mount Nittany Health, we are dedicated to delivering exceptional patient care through a blend of advanced clinical technology and empathetic healthcare professionals. Our mission is to enhance the quality and accessibility of healthcare in our community, and we strive to recruit only the most qualified individuals to support the populations we serve.
Position Overview:
The Claims Processing and Revenue Cycle Specialist is responsible for submitting claims to various insurance providers, including HMOs, Blue Cross Plans, Medical Assistance, and Medicare, utilizing standard hospital UB04 and 1500 forms via electronic and paper submissions in compliance with HIPAA regulations. This role involves verifying patient registrations to ensure all necessary information is accurately captured for billing purposes. The specialist will review all claims for correct departmental charges prior to submission and will communicate with insurance companies through phone and online platforms to stay updated on billing protocols. Additionally, this position requires collaboration with physician offices to gather essential billing information.
Key Responsibilities:
- Process claims submissions in accordance with HIPAA standards.
- Review and verify patient registration details for accuracy.
- Ensure all departmental charges are correct before billing.
- Engage with insurance representatives to clarify billing procedures.
- Coordinate with medical staff to obtain necessary billing information.
Qualifications:
Education:
1) High School diploma or equivalent required.
2) Completion of an accredited medical secretarial Associate Degree program is preferred, along with a minimum of two years of relevant experience.
Experience:
1) Proven experience in a similar role, demonstrating a strong understanding of HIPAA compliance, coding, and billing practices.
Knowledge, Skills, and Abilities:
- Familiarity with HIPAA-compliant ICD-9 and ICD-10 CM diagnosis and procedure codes, as well as CPT-4 codes.
- Proficient in electronic claims submission using standard hospital forms.
- Ability to work collaboratively within a team environment.
- Strong communication skills for effective interaction with Mount Nittany Health staff and insurance professionals regarding billing and coding inquiries.
- Comprehensive understanding of UB04 and 1500 forms, along with CPT-4 code review processes.
- Thorough knowledge of the claims submission process and the billing requirements of various third-party payers, including Medicare, Medicaid, Blue Cross, and HMOs.
Licensure/Certification:
No specific licensure or certification is required for this position.
Supervision:
This role operates under the general supervision of the Manager of Revenue Cycle and the Supervisor of Patient Billing.
