What are the responsibilities and job description for the Billing Specialist position at ECU Health?
ECU Health
About ECU Health Medical Center
ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.
Position Summary
The Billing Specialist ensures consistent edit resolution to promote optimal reimbursement by timely
completion and appropriate management of pre and post billing edits. Generating, reviewing and
transmitting claims for hospital and physician services to government and/or non-government payors.
Collaborating across Revenue Cycle departments to ensure billing edits and other up-front billing-related issues are resolved completely and efficiently. Attention to detail is a critical component of this position, as well as the ability to communicate with insurance companies, other areas within the revenue cycle, and
clinical areas.
Responsibilities
1. Responsible for all pre-bill edits and claim scrubber edits for accuracy and compliance with all government and commercial carriers billing guidelines before releasing for submission to payers.
2. Responsible to bill all services within a timely filing as defined by departmental goals and insurance guidelines.
3. Responsible for all billing related denials to identify trends to improve clean claim rates.
4. Responsible for multiple daily reporting of billing indicators through various reporting tools
5. Bills hardcopy claims attaching any needed documentation for payment.
6. Pulls EOB's and Medical Records as needed attaching to claims and mailing.
7. Contact patients. insurance, any third party for insurance information or any additional billing data.
8. Performs rebill projects and additional daily reports.
9. Must understand and comply with the rules regarding edits.
10. Must possess a good working knowledge of the UB04 and CMS 1500 claim form and the data elements/field data required.
11. Understands and adheres to state and federal regulations and system policies regarding compliance, integrity and ethical billing practices.
12. Work and completes appropriate reports and workqueues.
13. Escalate issues with payers and reports improvement as appropriate.
14. Complete special reports or projects as assigned by Supervisor/Manager or Director.
Minimum Requirements
High School Diploma or equivalent required
4 years electronic billing and/or billing editing experience in a hospital and/or physician office setting.
Working knowledge of HCPCS. CPT-4 and ICD-10 coding and medical terminology.
Familiar with multiple payer requirements and regulations for claims processing
Preferred License/Registration/Certifications
Certified Revenue Cycle Associate (CRCA)
Certified Professional Coder- Hospital Services (CPC)
Certified Coding Specialist (CCS)
Epic experience a plus.
Knowledge, Skills and Abilities
Ability to work independently in carrying out oral and written instructions.
Apply knowledge of CPT, HCPCS and ICD-10 coding guidelines, billing documentation and documentation standards to daily claims management.
Excellent problem solving, analysis, organizational and time management skills.
Excellent communication and customer service skills with the ability to cooperatively resolve end user issues quickly and accurately, while building relationships with internal personnel and external contacts
Strong attention to details, accuracy and completeness of work products and thoroughness of research, data entry and recordkeeping.
Computer proficiency with Microsoft (Word, Excel, Outlook, Power point) and Internet applications.
Knowledge of third-party physician billing along with a demonstrated understanding of automated processes and claims submission
Demonstrates the ability to accurately manage detailed information.
Proficient in using billing software and Microsoft Office Suite (Excel, Word)
Understands basic medical terminology.
Excellent analytical and problem-solving skills
Ability to effectively communicate with internal teams and external clients.
Leadership skills with the ability to motivate and develop a team.
Works well under pressure
General Statement
It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.
Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.
We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant's qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.
