Insurance Billing Specialist (hybrid), full time, days

About the position Insurance Billing Specialist Provide exemplary customer service. Works daily electronic billing system (Cerner & nThrive) and submits insurance claims to third-party payers; reviews daily claim edits from the hospital billing system and makes necessary corrections to allow electronic submission. Assessing and analyzing claim edits daily within the billing system leading to a resolution within 24-48 hours. Maintains a thorough understanding of federal and state regulations as well as requirements specific to Medicare, Medicaid, and fiscal intermediaries in order to promote compliant claims submission practices for governmental claims. Communicates any edits that may need joint resolution with external departments. Prepares and submits manual insurance claims to third-party payers who do not accept electronic claims or who require special handling. Resubmission of claims that may need corrections. Verify that claims have been received by the appropriate payer. Investigate and resolve any issues in regards to claim transmission. Mail/Fax/Email paper claims to the appropriate payer the day they are generated. Performs effective, timely and efficient follow-up on all outstanding debit and credit balances within the expected time period. Review and analyze outstanding debit and credit balances to determine appropriate follow-up. Contributes innovatively to the success of our department and is compliant in all patient and billing aspects. Maintains a base-line understanding of federal and state regulations, as well as specific payer requirements and explanation of benefits to ensure compliance. Effectively handles communications, including email, telephone and instant message, from payers and departments within and outside of the department. Understands and maintains compliance with HIPAA guidelines when handling patient information. Reviews, processes, and resolves all incoming patient and insurance correspondence within one business day. Reviews and prepares responses to correspondence from patients and insurance carriers within a reasonable time frame. Responds to formal communication, both external and internal, within a reasonable time frame. Documents all activity taken within an encounter in the billing system. Clear and concise messaging. Responsible for making and documenting timely phone calls to insurance in regards to billing matters within the billing system. Provides updates to existing policies and procedures as needed and proposes new. Communicates with staff routinely and effectively using all forms of communication. Builds relationships and fosters positive communication with applicable departments outside of PFS. Documents all activity - each time an account is touched - in the notes section of the AR Host I.S. System, at the account level, appropriately, timely, compliantly and thoroughly. Stays current on healthcare regulations. Attends training sessions, internal and external. Performs other related duties as assigned. Holland Hospital is an Equal Opportunity Employer, please see our EEO policy

Responsibilities

• Provide exemplary customer service.
• Works daily electronic billing system (Cerner & nThrive) and submits insurance claims to third-party payers
• Reviews daily claim edits from the hospital billing system and makes necessary corrections to allow electronic submission.
• Assessing and analyzing claim edits daily within the billing system leading to a resolution within 24-48 hours.
• Maintains a thorough understanding of federal and state regulations as well as requirements specific to Medicare, Medicaid, and fiscal intermediaries in order to promote compliant claims submission practices for governmental claims.
• Communicates any edits that may need joint resolution with external departments.
• Prepares and submits manual insurance claims to third-party payers who do not accept electronic claims or who require special handling.
• Resubmission of claims that may need corrections.
• Verify that claims have been received by the appropriate payer.
• Investigate and resolve any issues in regards to claim transmission.
• Mail/Fax/Email paper claims to the appropriate payer the day they are generated.
• Performs effective, timely and efficient follow-up on all outstanding debit and credit balances within the expected time period.
• Review and analyze outstanding debit and credit balances to determine appropriate follow-up.
• Contributes innovatively to the success of our department and is compliant in all patient and billing aspects.
• Maintains a base-line understanding of federal and state regulations, as well as specific payer requirements and explanation of benefits to ensure compliance.
• Effectively handles communications, including email, telephone and instant message, from payers and departments within and outside of the department.
• Understands and maintains compliance with HIPAA guidelines when handling patient information.
• Reviews, processes, and resolves all incoming patient and insurance correspondence within one business day.
• Reviews and prepares responses to correspondence from patients and insurance carriers within a reasonable time frame.
• Responds to formal communication, both external and internal, within a reasonable time frame.
• Documents all activity taken within an encounter in the billing system. Clear and concise messaging.
• Responsible for making and documenting timely phone calls to insurance in regards to billing matters within the billing system.
• Provides updates to existing policies and procedures as needed and proposes new.
• Communicates with staff routinely and effectively using all forms of communication.
• Builds relationships and fosters positive communication with applicable departments outside of PFS.
• Documents all activity - each time an account is touched - in the notes section of the AR Host I.S. System, at the account level, appropriately, timely, compliantly and thoroughly.
• Stays current on healthcare regulations.
• Attends training sessions, internal and external.
• Performs other related duties as assigned.

Requirements

• High school diploma/GED or higher education

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