Billing Specialist

ESSENTIAL FUNCTIONS

• Maintains productivity and accuracy metrics per department expectations.
• Responsible for working claim errors in claims management system ensuring clean claims are submitted timely to insurance carriers.
• Reviews insurance rejections to determine next appropriate action steps and obtain necessary information to resolve any outstanding rejections.
• Correct and identify billing errors and resubmit claims to insurance carriers.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
• Assist in identifies and communicating trends and/or potential issues to management team.
• Payer website user access maintenance.
• Responsible for system maintenance of Athena master files including referring provider information, accurate insurance plan information and payer enrollments.
• Responsible for EDI, ERA and EFT enrollments for all payers.

EDUCATION

• High school diploma or GED

EXPERIENCE

• Minimum two to three years of experience in medical billing. Experienced candidates will have prior experience working claim errors in a claims management system. Prefer candidates with knowledge of ERA/EFT enrollment as well as ANSI formatting.

REQUIREMENTS

• Requires demonstrated knowledge of revenue cycle applications. Prefer prior experience configuring revenue cycle vendor-supplied software.

KNOWLEDGE

• Knowledge of ICD-10, HCPS, and CPT codes, medical terminology, and billing practices.
• Advanced computer knowledge, including Window based programs.
• Knowledge of EDI formats; ability to read and interpret ANSI X12 270/271, 835 and 837 file formats.

• Knowledgeable in both the billing processes utilized and is also knowledgeable with the specific applications that support those processes within the revenue cycle.

SKILLS

• Possesses strong organizational skills and careful attention to detail.
• Skill in effective data collection and analysis.
• Skill in using computer programs and applications.
• Must demonstrate quality communication skills, exhibiting a professional and ethical attitude at all times.
• Skill in effectively managing multiple projects simultaneously.

ABILITIES

• Ability to multitask in a fast-paced environment. Must be detailed oriented with strong organizational skills.
• Ability to understand patient demographic information and determine insurance eligibility.
• Ability to work independently, and as part of a team.

ENVIRONMENTAL WORKING CONDITIONS

• Normal office environment.

PHYSICAL/MENTAL DEMANDS

• Requires sitting and standing associated with a normal office environment. Some bending and stretching required. Manual dexterity using a calculator and computer keyboard

ORGANIZATIONAL REQUIREMENTS

• HOPCo Mission, Vision and Values must be acknowledged and adhered to
• List additional organization requirements such as training conducted by organization

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.