Position Summary
The Billing Specialist is responsible for all aspects of billing inpatient and outpatient claims. As a key position in the revenue cycle, this role facilitates the claims process, including accurate and timely claim creation, follow-up, and correspondence with providers, insurance inquiries, and patients. The incumbent will also assist in clarifying and developing process improvements and inquiries in order to maximize revenues.
Work is typically performed in an office environment, but this position has the option to work from home and may also be needed onsite for projects or team meetings from time to time. The role requires compliance with all organization policies and procedures, and all job-specific obligations.
Essential Duties and Functions
- Perform and monitor all steps in the billing process to ensure maximum reimbursement from patients, government and commercial payers, and special billing arrangements
- Prepare and submit clean claims to third-party payers electronically or by paper
- Follow billing guidelines and legal requirements to ensure compliance with federal and state regulations
- Respond to account inquiries from patients, payers, providers, and other staff as requested
- Identify and resolve patient and insurance billing issues
- Work closely with team members regarding claim appeals, denials, resolution, and education
- Understand Medicare, Medicaid, and other commercial payer rules and regulations applicable to billing
- Update providers, learners, office staff, clinics, and faculty on relevant billing changes
- Contribute to coding, billing, and documentation education related to billing errors
- Contribute to new learner education related to billing and collections
- Understand the considerations of coding in value-based payment contracts
- Review and implement changes from payer bulletins
- Use online healthcare databases and other resources for verification and claim status
- Deliver high-quality service to internal and external customers
- Assist team members with projects as needed
- Maintain strict confidentiality and adhere to HIPAA guidelines and regulations
Preferred Qualifications
- Certified Biller
- FQHC billing experience
Location
Pennsylvania, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
1 year ago