Billing Specialist 1

General Summary

The Billing Specialist I at Phelps Health is responsible for collecting and entering claims, submitting claims to insurance companies, answering patient inquiries, and resolving issues related to patient accounts.

Essential Duties And Responsibilities

• Enters information necessary for insurance claims such as patient, insurance, and insurance ID.
• Insures claim information in complete and accurate.
• Sets insurance claims to clearinghouse or individual insurance companies electronically or via paper UB04 and/or CMS-1500 form.
• Answers patient questions on patient responsible portions, copays, deductibles, write-offs, etc., and resolves patient's complaints or explains why certain services are not covered.
• Follows up with insurance company on unpaid or rejected claims. Resolves issues and re-submits claims.
• Prepares appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany letter.
• Fulfills HIPAA guidelines in handling patient information.
• Might perform "soft" collections for patient past due accounts. This may include contacting and notifying patients via phone or mail.
• Understands managed care authorizations and limits to coverage such as number of visits.
• Verifies patient benefits eligibility and coverage as needed.
• Prepares and submits secondary claims upon processing by primary insurer.
• Follows standards of behavior including integrity, compassion, innovation, and philanthropy.

Job Qualifications

• High School Diploma or GED required.
• Medical billing experience highly preferred.
• Experience in billing software and electronic data submission preferred.

Standards of Behavior

• Integrity: Personally accountable for doing what is always right.
• Compassion: Act on the empathy felt toward the needs of patients and families.
• Innovation: Be inspired to provide care in new and creative ways.
• Philanthropy: Be a good steward of the gift of time, deeds, and resources for our patients and community.

Working Conditions

• Standard office conditions with more than average noise.
• Periodic contact with conditions such as fumes, noise, chemicals, hazards, and/or diseases.
• Occasionally lifts and transports items weighing up to ten (10) pounds.