Specialist-Insurance Billing

Job Requirements

Position Summary

The Insurance Billing Specialist is responsible for a range of billing processes related to managing the ready to bill unbilled revenue. This position is responsible for the timely and accurate billing of all patient accounts to meet and/or exceed our departmental goals for cash collections and AR.

Minimum Requirements

Education

• High School Diploma or equivalency

Experience

• Must have had at least 4 years electronic billing and/or billing editing experience in a hospital and/or physician office setting.
• General Knowledge of HCPCS, CPT-4 and ICD9-10 coding and/or medical terminology.
• Familiar with multiple payer requirements and regulations for claims processing
• Solid Microsoft Office skills required.
• Good communication skills and the ability to courteously interact with multiple departments within SRHS

License/Registration/Certifications

• N/A

Preferred Requirements

Preferred Education

• Healthcare related Associates or Bachelor's degree

Preferred Experience

• 5+years billing experience in a hospital and/or physician billing setting.
• Experience in billing both technical and professional charges.
• Experience with DDE

Preferred License/Registration/Certifications

• Certified Revenue Cycle Associate (CRCA)
• Certified Professional Coder- Hospital Services (CPC-H)

Core Job Responsibilities

• 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.
• Understands and adheres to state and federal regulations and system policies regarding compliance, integrity and ethical billing practices.
• Must possess a good working knowledge of the UB04 and CMS 1500 claim forms and the data elements/field data required
• Responsible to bill all services within timely filing as defined by departmental goals and insurance guidelines.
• Must understand and comply with the rules regarding edits.
• Responsible for all billing related denials to identify trends to improve clean claim rates
• Responsible for multiple daily reporting of billing indicators through various reporting tools
• Must be able to accurately complete review and resolve all combined billing requirements to ensure compliance.
• Responsible to work all referrals within a 24/48-hour turnaround time from receipt.
• Exhibit good professional communication and customer service skills at all times while working with coworkers and employees in multiple departments within the system.
• Other duties as assigned