INSURANCE BILLING SPECIALIST, REVENUE CYCLE MEDICAL GROUP

Description

Location: SGMC Patient Financial Services
Department: REVENUE CYCLE MEDICAL GROUP
Schedule: Full Time, 8 HR Day Shift, 8-5

POSITION SUMMARY:

Responsible for processing incoming requests from various departments to bill manual and electronic claims to ensure timely and complete collection of all dollars assigned. Verifying patients’ insurance coverage. Answering billing questions from internal and external customers. Responsible for the timely billing, correction of edits, follow up of unpaid balances, and appealing of denials of professional charges for employed and contracted SGMC providers. Verifying patient’s insurance coverage and benefits. Answering billing questions from internal and external sources. Responsible for subset of payers and/or alpha split of payer groupings. Will be accountable for the overall health of the accounts receivables assigned. Responsible for daily review of correspondence, outstanding insurance credit balances, over-posted account balances, and paid claims with outstanding balances.

KNOWLEDGE, SKILLS & ABILITIES:

• Prior professional billing experience recommended.
• Compiles attachments, corrects claim edits, updates and bills on a daily basis all claims received from the electronic system.
• Submits claims in Epic PB Resolute Billing system.
• Documents and updates status of unpaid insurance balances.
• Researches and analyzes various billing reference manuals to review billing accuracy.
• Documents electronic system regarding returned faxes and Certified Return Receipts. Completes production logs. Processes outgoing mail. Verifies Medicare, Medicaid, and other 3rd Party eligibility using various systems.
• Technical/system skills/knowledge: PC and Windows literacy required; prefer knowledge of, or experience with, practice EHR systems, Medicare, Medicaid, and other payer web portals, Encoder Pro, Microsoft Office applications, and Experian claim source clearinghouse portal.
• Extensive knowledge of insurance/managed care, to include: Medicare; Medicaid (Georgia and Florida); Peach State; Wellcare; CareSource, Amerigroup; Tricare (Standard, Extra and Prime); VA; Disability Adjudication Services; Vocational Rehabilitation; Children’s Medical Services; Cancer State Aid; Crime Victim’s Compensation Program; Knight’s Templar Eye Foundation; Managed Care (HMO, PPO, POS, Medicare HMO); COBRA; Worker’s Compensation; Blue Cross (Georgia, Florida, out-of-state and FEP); and Institutional Billing.
• Working knowledge of CPT-4, HCPCS, and ICD-10.
• Knowledgeable of insurance and reimbursement process.
• Must have a thorough understanding and knowledge of: patient type; financial class; insurance master; place of service codes; physician coding;; relationship codes; accommodation, occurrence, value and condition codes.
• Related regulatory and legal requirements:; Medicare Secondary Payer Questions; medical necessity; Medical Reviews and Appeals. Interacts with:; patients; other departments; physician offices; acute medical care providers; insurance companies; employers; intermediaries; utilization review companies; state regulatory agencies (GMCF, Medicaid); and attorneys.
• Knowledge of medical terminology.
• Strong verbal/written communication skills, highly organized with the ability to prioritize work.
• Able to communicate effectively with a wide range of individuals.
• Substantive communication required with physicians, insurance companies, customers and staff.
• Must be highly organized and self-motivated, requiring little or no supervision to carry out duties. Ability to prioritize and execute multiple tasks to accomplish timely and effective resolution of patient accounts.
• Working knowledge of medical terminology, revenue, CPT and ICD-10 codes, and 1500 forms.
• Ability to review and completely understand an EOB, recognize problems, and communicate payer denial trends to supervisor which prohibit payment from insurance carriers.
• Ability to maintain acceptable levels of productivity with minimal errors. Requirement is 60 accounts minimum per day once training is completed.
• Strong analytical, interpersonal and communication skills required.
• Excellent PC and data entry skills essential.
• Familiarity with HIPAA privacy requirements for patient information.
• Excellent customer service skills. CPAR certification highly desirable.

WORKING CONDITIONS- ADA INFORMATION:

Modern, well lighted, air conditioned, general work area. Moderate noise level. Normal business setting with moderate to high stress in accomplishing daily responsibilities. Subject to irregular schedule including evenings, nights, weekends and holidays. Occasional overtime required. Ability to sit, stand or walk for moderate periods. Safe and efficient operation of office equipment including: copier, fax, printers, computer, telephone and adding machine. Reading of printed materials, including physician orders. Listening and verbally responding to customers, staff, physicians and visitors. Moderately heavy lifting {0-25 lbs.}, reaching, stooping, pushing, pulling, bending, and twisting.