Billing Specialist I

Overview

This role involves the timely submission of technical or professional medical claims to insurance companies, supporting healthcare organizations in improving their revenue cycle.

Responsibilities

• Verify patient, billing, and claim information for accuracy using various hospital/physician systems
• Perform compliant primary, secondary, tertiary, and rebill billing functions, including electronic, paper, and portal submissions to payers
• Edit claims to meet billing compliance guidelines for electronic and hardcopy submissions
• Respond promptly to emails and telephone messages
• Communicate payer, system, or escalated account issues to management
• Participate in meetings, training seminars, and in-services to develop job knowledge
• Adhere to professional standards, hospital policies, federal, state, and local requirements, and JCAHO standards
• Take ownership of new and different requests to enhance the billing department and hospital reputation
• Update patient demographics and insurance information in appropriate systems
• Monitor claims for missing information, authorizations, and control numbers (ICN/DCN)
• Follow guidelines for prioritization, timely filing deadlines, and notation protocols
• Secure necessary medical documentation required or requested by third-party insurance carriers
• Maintain confidentiality of patient information according to insurance collection guidelines and corporate policies
• Perform other related duties as required

Requirements

• 1-2 years of medical collections/billing experience
• Basic knowledge of ICD-10, CPT, HCPCS, and NCCI
• Basic knowledge of third-party billing guidelines
• Basic knowledge of billing claim forms (UB04/1500)
• Basic knowledge of payor contracts
• Working knowledge of Microsoft Word and Excel
• Basic working knowledge of health information systems (e.g., EMR, claim scrubbers, patient accounting systems)

Preferred Qualifications

• Working knowledge of one or more patient accounting systems such as EPIC, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts, or Paragon
• Working knowledge of DDE Medicare claim system
• Knowledge of government rules and regulations

Compensation & Benefits

• Salary range: $18.00 to $20.00 per hour
• Specific compensation varies based on geographic location, candidate experience, certifications, and skills

Equal Opportunity

The employer is an Equal Opportunity Employer and does not discriminate based on race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity, or any other protected class.

Location

This role may be subject to state-specific laws regarding salary disclosure and employment regulations.