Revenue Cycle Billing Specialist

The Revenue Cycle Billing Specialist primary objective is to provide support for all aspects of insurance billing, denial management, payment posting, and accounts receivable follow up in accordance with revenue cycle protocol with an emphasis to meet business needs and stay in alignment with the company’s strategic plans. This position will have direct contact with the appropriate third-party payers for all unpaid claims including denied claims and those requiring appeals, as well as non-payment, overpayments, recoups and underpayments.

Primary responsibilities include reviewing and working claims edits prior to submission for accuracy and working denials to achieve payment for claims from payers through making calls, appeals and resubmitting corrected claims.

Essential Job Functions:

• Accurately processing medical billing and ensuring timely submission to third-party payers.
• Research denials by interpreting the explanation of benefits or remittance codes and prepares appeals for underpaid or denied claims
• Provide feedback to management on trending denials or claim payment issues.
• Ability to cross train and work to achieve accurate authorizations or identify issues which need further review to ensure clean claims are send out on the first submission
• Check claim status on appropriate payor systems and contact insurances as needed
• Denial and insurance follow up management for batched issues and individual claims
• Issues adjusted, corrected and /or rebilled claims to third-party payers
• Post payments, adjustment, transfer of responsibility and refunds, as necessary
• Work with the revenue cycle team to assists with meeting daily, monthly, and quarterly billing metrics
• Responsible for understanding and reviewing clinical billing codes in relation to payor contracts, billing guides and other relevant sources (Service Encounter Reporting Instructions – SIRI guide).
• Responsible to work with other teams, including but not limited to: Electronic Health Records Team (EHR), Finance & Clinical
• Respond to the directives of the supervisor and or management staff in a professional and cooperative manner.
• Assure that all patient needs are met with dignity and respect.
• Understands and facilitates federal confidentiality laws, 42 CFR, and protects client confidentiality/anonymity, and assures no information is shared without proper authorization.
• Compliance and understanding of HIPAA laws
• Other duties as assigned

Minimum Requirements

• 2-4 years of medical billing experience or equivalent education/certifications in medical billing
• Behavioral Health & Substance Abuse Preferred (Not Required)
• Admission/facility claims billing experience
• Familiar with billing guidelines and regulations in various states; across government and non-government 3 party insurance carriers
• Strong medical billing A/R follow up
• Experience with electronic funds transfers
• Experience with 835i & 835p files
• Experience with medical billing Forms: 1500 and UB04
• Experience with Medicaid State Eligibility System
• Working knowledge of CPT and ICD-10 coding systems
• Experience with medical software programs, payor portals, Microsoft office products
• Highly organized and detail oriented
• Excellent communication (written and oral) and interpersonal skills.
• Demonstrate time-management skills and understanding of priorities & supervisor’s directives
• Ability to work in a fast paced and rapidly changing environment both independently and as a team member
• Understanding of medical terminology, medical billing practices and billing reimbursement is essential
• Strong computer and typing skills
• Excellent communication skills

Physical Demands and Work Environment:

Must be able to see, hear, sit, stand, lift, and walk. Must be able to lift 10 pounds. Must be able to use a computer keyboard and view monitor for long periods of time. Ability to use hands and fingers. Must be able to work with moderate noise (business office with computers, printers, light traffic).

Job Type: Full-time

Pay: $20.00 - $26.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Ability to Commute:

• Spokane Valley, WA 99037 (Required)

Ability to Relocate:

• Spokane Valley, WA 99037: Relocate before starting work (Required)

Work Location: Hybrid remote in Spokane Valley, WA 99037

Salary : $20 - $26