Billing Specialist - Radiation Oncology - Hopewell - Full-Time - DAYS

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in exceptional physicians, nurses, and staff, as well as advanced technology. Capital Health is a dynamic healthcare resource accredited by the DNV, including two hospitals, an outpatient center, a satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group consists of over 600 physicians and providers offering primary, specialty, and hospital-based services.

About the role

This position involves reviewing, updating, correcting, and approving daily case charges within the billing system. You will ensure the accuracy of medical, hospital, and facility charges, run daily reports to validate charges, and collaborate with nurses and other departments to resolve billing issues. The role also includes obtaining insurance pre-authorizations, coordinating peer-to-peer authorization processes, and acting as a resource for coding and billing inquiries.

Responsibilities

• Review, update, correct, and approve daily case charges from sites within the billing system.
• Enter all medical, hospital, and other facility charges into the billing system and ensure their accuracy.
• Verify charges for supplies, rooms, and other medical expenditures to ensure correct entry for proper reimbursement.
• Run daily reports for cases and documents to validate accurate charges.
• Collaborate daily with nurses to add, change, update charges, or documentation.
• Assist in obtaining insurance pre-authorizations for patient consults, exams, treatments, and imaging.
• Follow up on pending authorizations by providing necessary clinical documentation or answers to questions.
• Develop spreadsheets to track pre-authorizations and treatment codes to ensure compliance with treatment plans.
• Coordinate peer-to-peer authorization processes when authorizations are denied.
• Obtain base prices for specific charges and manually enter them into the billing system.
• Act as a resource for the department on coding and billing issues.
• Follow up with outside departments on billing-related questions, clarifications, or updates.
• Verify that all supply charges have been received against final patient orders and documentation.
• Revise and correct billing discrepancies provided by the billing department.
• Assign codes accurately in accordance with coding guidelines and apply special codes for correct billing.
• Manually charge post the cap price CDM for all required from a capped price agreement.
• Discuss medical record information with physicians when necessary, following coding guidelines.
• Contact physicians or other staff to obtain missing documentation or signatures in a timely manner.
• Assist Medical Records, Compliance, and Finance Departments with the appeals process by providing necessary documentation.
• Track medical records requests from the Patient Account Department and review for compliance.
• Prepare and communicate medical records reports and overdue records to appropriate parties to satisfy claims and increase revenue.
• Perform other duties as assigned.

Requirements

• High school diploma or GED.
• Two years of medical insurance, insurance pre-authorization, billing, or coding experience.
• Previous hospital billing experience preferred.

Qualifications

• Intermediate experience with billing.
• Familiarity with insurance language.
• Basic understanding of coding preferred.
• Basic computer skills.
• Understanding of ICD-9 and CPT coding classifications.
• Thorough knowledge of medical terminology, anatomy, and physiology.

Skills

• Strong interpersonal skills.
• Able to interact with insurance companies and physicians.
• Works well in team settings.
• Excellent organizational and follow-up skills.

Physical Demands and Work Environment

• Frequent physical demands: Sitting, wrist position deviation, pinching/fine motor activities, keyboard use/repetitive motion.
• Occasional physical demands: Standing, walking, climbing (e.g., stairs or ladders), carrying objects, pushing/pulling, twisting, bending, reaching forward, reaching overhead, squatting/kneeling/crawling.
• Continuous physical demands: Lifting from floor to waist (15 lbs), lifting waist level and above (10 lbs).
• Sensory requirements: Accurate near vision, accurate far vision, color discrimination, minimal depth perception, minimal hearing.
• Anticipated occupational exposure risks: Dust/particulate matter.

Pay

The pay range for this full-time equivalent (1.0 FTE) position is $21.33 - $27.73 per hour. Actual compensation may differ depending on assigned hours and position status (e.g., part-time).

Schedule

Scheduled weekly hours: 40.

Benefits

• Medical Plan
• Prescription drug coverage & In-House Employee Pharmacy
• Dental Plan
• Vision Plan
• Flexible Spending Account (FSA) – Healthcare and Dependent Care
• Retirement Savings and Investment Plan
• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
• Supplemental Group Term Life & AD&D Insurance
• Long Term Disability (LTD) and Short Term Disability (STD) Benefits
• Employee Assistance Program
• Commuter Transit and Parking Benefits
• Voluntary Life Insurance for Employee, Spouse, and Child
• Voluntary Legal Services
• Voluntary Accident, Critical Illness, and Hospital Indemnity Insurance
• Voluntary Identity Theft Insurance
• Voluntary Pet Insurance
• Paid Time-Off Program