Billing Specialist I

About the role

Under direct supervision, performs all billing and collection functions on account balances within assigned financial classes. Ensures timely submission of all claims and timely follow-up. Posts payments in EPIC. Performs eligibility, verification, and authorization requests as needed.

Responsibilities

• Manages assigned Epic work queues daily to ensure accurate billing and expedient claims follow-up.
• Ensures timely submission and follow-up of all claims within assigned financial classes.
• Investigates claim denials or rejections and completes functions to resolve claims using tools such as online access, calling insurance companies, and working with provider representatives.
• Identifies appeals and secondary billing for accounts with secondary liability; follows up on unpaid balances and brings claims to resolution.
• Identifies patient self-pay balances and bills timely to patient/family; follows up as necessary, including calling for follow-up.
• Processes late charge claims, resubmissions, and/or corrections to payors.
• Enters and posts payments to patient accounts based on remittance advice review; reconciles accounts to correct underpayments or overpayments.
• Responds to patient and third-party payor inquiries regarding patient accounts via email, telephone, mail, and in person.
• Audits primary patient bills for submission to third-party payors via electronic billing or manual claim submission.
• Maintains detailed and accurate billing records for auditing purposes and compliance with industry regulations.
• Participates in meetings with Provider Reps to resolve denial discrepancies.
• Prepares and submits appeals for denied claims, including understanding additional documentation necessary for appeals.
• Ensures compliance with federal, state, and local billing laws, including HIPAA regulations.
• Prepares reports recommending accounts for bad debt adjustments and maintains lost revenue at less than 1% of net healthcare revenue.
• Recommends accounts for transfer to bad debt.

Requirements

• High School diploma or equivalent required; Associate’s degree preferred.
• Two years of medical billing experience and one year of experience with electronic billing.
• Epic experience desired.

Skills

• Thorough knowledge and understanding of medical billing, insurance, and private pay.
• Knowledge of medical billing requirements for Medicare, Blue Cross, Medical Assistance, Commercial insurance, and HMO carriers.
• Strong collection skills, including claims follow-up and revenue cycle practices.
• Strong computer skills, including EMR knowledge and Microsoft Office (Excel preferred).
• Strong interpersonal, verbal, and written communication skills for interacting with patients, families, insurance companies, and healthcare providers.
• Ability to investigate issues, find solutions, and work under pressure to resolve billing issues.
• Efficient in managing multiple tasks, prioritizing, and ensuring deadlines are met.
• Ability to handle multiple claims and billing tasks simultaneously while maintaining quality and accuracy.

Physical Requirements

• Ability to sit, concentrate, and pay close attention to detail.

Working Conditions

Normal office environment with little exposure to excessive noise, dust, or temperatures.

Pay

Pay Range: $19.92 - $29.87. Final salary offer will be based on the candidate's qualifications, education, experience, and alignment with organizational needs.

GBMC Values

• Respect: Treats others with fairness, kindness, and respect for personal dignity and privacy; listens and responds appropriately to others’ needs, feelings, and capabilities.
• Excellence: Meets and/or exceeds customer expectations; actively pursues learning and self-development; pays attention to detail and follows through.
• Accountability: Sets a positive, professional example; takes ownership of problems and does what is needed to solve them; appropriately plans and utilizes required resources; reports to work regularly and on time.
• Teamwork: Works cooperatively and collaboratively with others for the success of the team; addresses and resolves conflict in a positive way; seeks out the ideas of others to reach the best solutions; acknowledges and celebrates the contribution of others.
• Ethical Behavior: Demonstrates honesty, integrity, and good judgment; respects the cultural, psychosocial, and spiritual needs of patients/families/coworkers.
• Results: Embraces change and improvement in the work environment; continuously seeks to improve the quality of products/services; displays flexibility in dealing with new situations or obstacles; achieves results on time by focusing on priorities and manages time efficiently.