HOSPITAL BILLING SPECIALI - MEDICAL CENTER FINANCIAL SVCS
Status: Full Time
Shift: Mon-Fri 8:00 - 4:30, rotating weekends.
Performs account follow-up and resolution of patient receivables.
High school graduate or equivalent is required.
Hospital or professional billing experience or completion of Billing and Coding technical curriculum is required.
Experience with financial accounting, budgeting, reporting or payroll processing can be substituted for billing experience.
Working knowledge of billing and reimbursement policies of third party payors.
Data entry and computer skills. Excellent written and oral communication skills.
1. Daily obtain Insurance information and add appropriate carrier/plan information, ensuring that all steps have been completed so that proper billing, follow up and reimbursement can be obtained.
2. Have working knowledge of Governmental, State and insurance billing guidelines and insurance reimbursement. Consecutive account WQ must be reviewed daily to ensure billing guidelines are met. All accounts must be billed and collected in accordance with the timely filing limits of each payer.
3. Review, process and maintain follow up on outstanding accounts assigned by work queue designation and/or ATB Reports.
4. Research and write up account adjustments on the proper adjustment form and route for the appropriate signatures of authorization, as outlined in the adjustment policy when necessary.
5. Call patients to obtain financial information, insurance information, and discussing status of accounts when necessary.
6. Analyze credit balance accounts in assigned work queue to process third party, patient refunds and correct the misapplication of funds when necessary.
7. Contact Medicaid, Medicare, Commercial Insurances, and/or Third Party Payers for status of claims on a daily basis.
8. Transfer balances to patient balance daily after insurance pays, denies or when deemed appropriate.
9. Request medical records when needed to process claims.
10. Research and determine the necessary actions needed to resolve accounts within designated time frame set by insurance payers.
11. Research and determine the necessary actions needed to resolve denied accounts/charges for all payers listed on Explanation of Benefits and/or Remittance Advices on a daily basis.
12. Check status on Medicaid, Medicare, and /or Insurance accounts via various electronic systems on a daily basis.
13. Document in notes all information and activities pertaining to the account on a daily basis. (who, what, why, when and where)
14. Consistently have open communication with all hospital departments.
15. Maintain confidentiality and adhere to HIPPA Compliance.
16. Attend in-services and other meetings as required.
17. Efforts must be made to achieve and exceed departmental goals on an ongoing basis.
18. Must maintain performance and productivity levels set within the performance indicators.
19. Follow North Oaks Health System policy and procedures, compliance program and all Federal and State regulatory guidelines.
20. Perform other duties as assigned.