Billing Specialist

Overview

The Billing Specialist manages the full scope of billing and claims processing for all contracted commercial and / or Workers Compensation payers. Initiates billing of primary and secondary claims for all Commercial and Workers' Compensation claims and resolves any rejected claims and rebills as needed. Reports and follows up on any registration and / or coding errors in order to timely process claims. Works closely with PFS Supervisor to timely resolve any outstanding commercial and Worker's Compensation billing and / or claim issues.

Responsibilities

Bills all primary and secondary Commercial and / or Worker's Compensation claims on the electronic billing system, or print- to-paper if appropriate. Ensures that billing edits reflect compliant billing practices.

Reviews claims for accuracy and completeness and provides documentation required for complete billing.

Maintains current knowledge of Uniform Billing (UB) forms and CPT, HCPC, ICD10 codes and modifiers. Resolves rejected claims and performs rebilling if needed. Reports any discrepancies to peers and Patient Financial Services (PFS) Supervisor.

Identifies recurring errors and corrections being made to claims and reports, such as remittance advises (RA) or explanation of benefits (EOB).

Reviews Commercial Payer classification on Aged Trial Balance report monthly and reviews for aging claims to ensure timely filing statutes are met. Manages work que in Paragon and reviews and resolves all correspondence timely and accurately.

Assumes responsibility for all secondary commercial billing and follow-up.

Cross training with Billing Specialists, Collection Specialist (front desk), and Patient Financial Analyst (cash posting) as back-up when needed. Other duties as needed including; opening and sort incoming mail, scanning all payer correspondence, and running daily credit card payments.

Qualifications

Education : High School Diploma or equivalent.

Experience : Two years' previous billing and follow-up experience in a hospital or healthcare setting preferred.

Licenses & Certifications : N / A

Required Skills & Knowledge : Must have a solid understanding of Commercial, Federal, and Worker's Compensation regulations and facilities current payer contracting agreements within 90 days of hire. Adheres to federal and state regulations including HIPPA and The Fair Debt Collection Practice Act. Proficient with a 10-key. Must understand medical terminology. Excellent follow up skills. Must be organized, detail oriented and meet all claim filing deadlines. Able to operate in multiple software systems and be proficient in Microsoft Office applications.

Compensation

Actual compensation takes into account several factors including but not limited to a candidate's experience, education, skills, licensure and certifications, department equity, training and organizational needs. Eligible roles also qualify for a comprehensive benefits package.

Minimum : USD $23.43

Maximum : USD $30.47