Summary

The main objective of this position is to ensure correct processing of all insurance claims of all hospitals. Able to interpret & implement specified insurance billing guidelines. Coordinates all facets for insurance billing, credits and collection of A/R. This role ensures duties are completed accurately and timely while acting as a team player for optimum office flow and excellent patient service. Performs other duties as assigned.

Responsibilities

Responsible for clear, detailed communication with the clinical and billing staff along with payers and clients regarding various insurance and payment related issues.

Bill and submit claims for all insurance companies according to payer specific guidelines and established procedures and workflow. Be knowledgeable of payer updates as it relates to bundling and unbundling charges, medical necessity and general coding specifications.

Review and process adjustments as needed for accounts to avoid claim release if not needed but also recognize and resolve credit balances as needed.

Able to resolve all front end claim edits and clearinghouse returns so that claim can be resubmitted in a timely matter to payers/insurance carriers.

Responsible daily for the correction of primary/secondary rejected claims, the resubmission of rejected claims, along with resolution of all delinquent insurance claims on patient accounts, per guidelines, in order to secure payment.

Assist the Supervisor with other functions.

Completes assigned goals.

Requirements, Preferences and Experience

Education

Preferred: One to 3 years medical claims billing or processing with some college, vocational or certification in the insurance industry.

Minimum: One to 3 years medical claims billing or processing with some college, vocational or certification in the insurance industry.

Experience

Preferred: Experience in medical billing, previous employment in the insurance industry, or professional certification, three to five years preferred.

Minimum: Experience in medical billing, previous employment in the insurance industry, or professional certification, three to five years preferred.

Special Skills

Preferred: Knowledge of ICD-9/ICD-10, CPT and HCPCS codes, Compliance, OSHA, and HIPPA regulations.

Minimum: Ability to read, understand, interpret and resolve payer front end denials Ability to research payer regulations and determine appropriate claim submissions Ability to utilize multiple patient accounting and billing applications including but not limited to connect systems, claims clearing house systems, payer systems, internet. Ability to interface with the staff at the insurance carriers and hospital personnel. Ability to read, write and understand documents, correspondence, and memos Ability to effectively present information one-to-one and in group situations to customers, clients, and other employees in the organization Critical thinking skills required Effective PC skills

Training

Preferred: Experience with MS Word, Excel and ability to learn new computer programs

Minimum: PC Skills Keyboarding 35-50 words per minute

About Baptist Memorial Health Care

At Baptist, we owe our success to our colleagues, who have both technical expertise and a compassionate attitude. Every day they carry out Christ's three-fold ministry-healing, preaching and teaching. And, we reward their efforts with compensation and benefits packages that are highly competitive in the Mid-South health care community. For two consecutive years, Baptist has won a Best in Benefits award for offering the best benefit plans compared with their peer groups. Winners are chosen based on plan designs, premiums and the results of a Benefits Benchmarking Survey.

At Baptist, We Offer:

Competitive salaries

Paid vacation/time off

Continuing education opportunities

Generous retirement plan

Health insurance, including dental and vision

Sick leave

Service awards

Free parking

Short-term disability

Life insurance

Health care and dependent care spending accounts

Education assistance/continuing education

Employee referral program

Job Summary:

Position: 11997 - Specialist-Billing Senior

Facility: BMG - Central Business Office Jackson

Department: BMG JS Patient Financial Services

Category: Billing Claims and Revenue

Type: Non Clinical

Work Type: Full Time

Work Schedule: Days

Location: US:MS:Jackson

Located in the Jackson, MS metro area REQNUMBER: 21986