Billing Specialist

Billing Specialist

At Evergreen and our affiliates, we value collaborative, down-to-earth individuals and encourage self-expression. We recognize that our diverse workforce allows us to provide culturally competent care to everyone in our community.

The Billing Specialist is primarily responsible for processing insurance claims, which includes submitting claims, posting payments, reviewing denials, and working with insurance companies to resolve payment issues while adhering to insurance specific timely guidelines.

As part of the Essential Functions of this role, the Billing Specialist :

• Submits clean claims to insurance companies and meets timely filing requirements.
• Posts insurance payments manually and electronically. Ensures all codes are being reimbursed according to payer contracts.
• Reviews claim denials and contacts insurance companies for resolution, as needed.
• Reports denial trends immediately to the supervisor.
• Addresses correspondence from Insurance Carriers on a weekly basis.
• Identifies Coordination of Benefits and / or incorrect patient insurance. Communicates findings to the Financial Counseling Center.
• Reviews claim rejections and makes all necessary corrections to resubmit claims.
• Assists patients with questions regarding Explanation of Benefits (EOBs), co-payments, personal balances, and all other questions regarding the billing process.
• Collects, posts and manages patient account payments.
• Prepares, reviews, and submits patient statements file every 45 days.
• Reviews unapplied payments every 30 to 45 days and determines if refunds are necessary. Submits refund requests as needed either electronically or via invoice to Finance Department.
• Reviews claims data to ensure the assigned code(s) meet required legal and insurance rules.
• Maintains complete, current, and accurate files that comply with the Association's confidentiality policies.
• Maintains up-to-date billing information. May also be required to watch billing webinars periodically as assigned by the supervisor.

Qualified candidate will have a High School Diploma or equivalent; Medical Billing Certification (CPB or CMBS) preferred; candidate will have experience utilizing Electronic Medical Record software, Medent preferred; ideal candidate will have experience working within a primary care, behavioral health, pediatric and / or podiatry setting; candidate must be proficient in verbal, non-verbal and written communication with training experience preferred; familiarity with computers and MS Office software (Outlook, Word) required; awareness of and sensitivity to the issues and health disparities faced by underserved populations is essential.

Job type : Full Time

Required education : High School Diploma or equivalent; Medical Billing Certification (CPB or CMBS) preferred

Preferred experience : EMR software, preferably Medent

What Evergreen Health Offers You :