Billing Specialist II - Home Health Care - 40 Hours / Week

Business (Non-Clinical) - Community Care Services

Under minimal supervision, is responsible for the Henry Ford Health System Insurance accounts receivable. Identifies and determines in accordance with established policies and procedures the accuracy and completeness of patient financial, insurance and demographic patient information to ensure compliant claims to Third party payers. Resolves problem accounts from payer denials and follows up on any claims that require a payer response. Responsible for the billing and collection of payments for all Henry Ford Health System hospitals, outpatient clinics and employed physicians.

Essential Functions and Responsibilities :

• Submit third party claim forms (i.e. UB04 or 1500) through the claims editing software. Understands the claim editing process and resolving the edits based on appropriate department procedures regarding claim submission.
• Evaluate and investigate appropriate actions to be taken in order to resolve outstanding receivables, in accordance with department goals. Utilize various resources such as third party publications, procedure manuals and participating contractual agreements, etc.
• Understand and resolves third party rejections using the payer and the billing systems
• Utilize various resources such as third party publications, procedure manuals and participating contractual agreements, etc.
• Working knowledge of internal and external revenue cycle systems to manage receivables.
• Expert knowledge in all claims processing, including claims submissions, denials, and follow up procedures used to train other team members.
• Independently interact with various levels of management, physicians, clinic personnel to identify process improvements to enhance billing processes.
• Represent the CBO in all communications with external customers, including patients, third party insurance companies, auditors, lawyers, etc. May also attend external seminars, medications, and court sessions.
• Ensure that all appropriate financial adjustments are posted accurately and in accordance with contracted payment rates, third party billing requirements, and HFHS policies and procedures.
• Evaluate and validate correct payments received from third party payers if necessary.
• Stay current with knowledge of payer and regulatory changes.
• Department liaison for assist with internal or external special projects. Responsible for providing feedback and statistics reflating to the project.
• Identify and resolve credit balances and understand the impact on patient responsibility and third party refunding.
• Meet established quality and productivity expectation.
• Identifies, resolves and reports potential issues to leadership.
• Supports the standards set forth in the HFHS Code of Conducts by adhering to legal and ethical standards.
• Performs other related duties as assigned.

Education / Experience Required :