Billing Specialist I

Job Summary

Processing of claims, via electronic claims management system, by reviewing identified errors or rejections and resolving these issues appropriately. Also responsible for completing requests for rebilling of denied claims.

Essential Functions

• Bills all primary and secondary insurance claims in a timely and accurate manner.
• Demonstrates working knowledge of all appropriate billing forms, UB04, 1500 or state specified forms.
• Demonstrates working knowledge of the electronic billing system with and understanding of edits and reports.
• Working knowledge of federal, state, local and intermediary specific billing requirements to ensure appropriate authorizations are completed and/or notifies appropriate person of missing or incomplete billing requirements and follows up in a timely manner.
• Audits each bill/account for charges, duplications and overlapped accounts before billing, making any necessary adjustments and documenting appropriately.
• Resolves claim processing issues on a timely basis by reviewing claim inventories and taking appropriate action.
• Ensures accurate and complete clean claim submission for both paper and electronic claims in a timely manner.
• Maintains currency in regards to methods of billing, laws, or hospital rules relating to insurance claims and electronic submission claims.
• Completes the SSI daily balancing to completion each day. Communicates timely and in a professional manner with the Billing Services Manager for any issues or billing delays identified.
• Communicates with the Billing Service Manager for any charging trends or edit trends and provide examples and education to other departments (such as ancillary, patient access) to reduce errors.
• Performs under tight deadlines.
• Maintains current knowledge and understanding of government rules, regulations.
• Works with technology necessary to complete job effectively. This includes, but is not limited to, SSI, phone technology, PULSE/DAR products, eligibility tools, claim status, and scanning technology.
• Analyzes, researches and processes insurance claims through electronic claims management system in a timely manner.
• Ensures accurate and complete clean claim submission for both paper and electronic claims.
• Processes claim updates based on direction given by facility or coding liaisons.
• .valuates electronic insurance rejections in order to re-transmit with corrected claim information.
• Investigates rebill requests submitted to the billing department and processes these requests when appropriate.
• Audits claims/accounts for charges, duplications, and overlapped accounts prior to billing, making any necessary adjustments. Documents actions taken in collection system.
• Informs Billing Managers of any charging trends or edit trends and provide examples/education to other departments to reduce errors.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• H.S. Diploma or GED required
• Associate Degree preferred
• Less than 1 year experience in a hospital or medical facility setting, OR have taken a minimum of one college or certificate program course in related area. required
• 1-3 years billing experience in a medical facility, ambulatory surgery facility, or acute-care preferred

Knowledge, Skills and Abilities

• To perform this job successfully, an individual should have knowledge of Word Processing software, Spreadsheet software and E-mail software