Billing Specialist

The Billing Specialist is responsible for timely, complete, and accurate claims submission to third party insurance carriers. They ensure that each claim has active and accurate insurance information, authorizations in place (as needed) and billing and coding requirements are met to send a clean claim on first submission. The Billing Specialist utilizes their in-depth knowledge and understanding of Clearinghouse responses to analyze, research, and resolve claim errors and rejections in a high-volume environment.

Responsibilities:

Clean Claim on First Submission (70%):

• Ensures required patient demographic information is accurate and complete.
• Ensures insurance information is active and accurate prior to releasing claims.
• Ensures prior authorizations are active and accurate prior to releasing claims. Re-verifies and obtains new authorizations as needed.
• Ensures claim meets all payer billing and coding requirements prior to releasing claims.
• Ensures all charges and treatments are captured prior to releasing claims.
• Releases claims via the Clearinghouse for processing by third party insurance carriers.
• Prepares paper claims when required for submission by primary and/or secondary payers.

Claim Errors and Clearinghouse Rejections Resolution (30%):

• Resolves claim errors and clearinghouse rejections to resubmit claims in a timely manner.
• Researches required billing claim elements by state and payer.
• Researches and updates payer information including name, ID, and address discrepancies.
• Identifies claim error and clearinghouse rejection trends and works with supervisor/manager to put prevention mechanisms in place.
• Updates practice management system master files to ensure accurate claim submission.
• Works with insurance follow-up and intake regarding claim related issues.
• All other duties as assigned.

Requirements:

• 3 years minimum of institutional claims handling experience.
• 2 years minimum Clearinghouse experience preferred.
• 1 year minimum dialysis claims experience preferred.
• Dialysis billing software experience preferred.
• Knowledge of billing requirements for paper and electronic claim submission.
• Knowledge of payer specific billing and coding requirements across multiple states.
• Knowledge of payer timely filing deadlines and appeal requirements.
• Understanding of an Explanation of Benefits and UB04 form.
• Detail oriented and analytical.
• Knowledge in Microsoft Word, Excel and Outlook.
• Maintains confidentiality in compliance with HIPAA; and

• Able to sit and work at computer for extended periods of time

Benefits:

Depending on your job status, you may be eligible for the following benefits:

• Medical, Dental, Vision, & Life Insurance
• 401(k) package
• Flexible Spending Accounts
• Education Assistance
• Certification & Professional Membership Reimbursement

Compensation:

Compensation offers are based on education, experience, skills, and geographic region.