Billing Specialist II - PB

About the role

Phelps Health is a 2000-employee-strong hospital and healthcare system serving the heart of small-town Missouri. No matter where you start with us, we’re committed to taking our team to the top. If you’re ready for the challenge of providing life-saving care or supporting those who do, read on to find your fit in the Phelps Health family. The Billing Specialist II is responsible for collecting and entering claims, post insurance, submit claims, and answer patient inquiries on accounts. Reports to the Billing Supervisor. At Phelps Health, we think we have a better team, benefits, and opportunities for growth than anyone else around, and we invite you to see for yourself!

Responsibilities

• Enters information necessary for insurance claims such as patient insurance and insurance ID.
• Insures claim information is complete and accurate.
• Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper UB04 and/or CMS-1500 form.
• Be a secondary resource to answer patient questions regarding insurance claims processing and insurance coverage/payment issues, which may include explanation of patient portion amounts such as, copays, deductibles, and contractual adjustments.
• Follow up with insurance company on unpaid or rejected claims. Resolves issues and re-submits claims. If not able to resolve the issues, forwards the denial to DPR to review for appeal.
• Prepares appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany letter.
• Follows HIPAA guidelines in handling patient information.
• Recognize managed care contract terms and reimbursement methodologies. Resolve under/over payment disputes with payers based upon contracted terms and reimbursement amounts received.
• Verify patient benefits eligibility and coverage, using the payer portal or contacting the payer directly, as needed.