Commercial Billing Specialist

Education

High School diploma or equivalent required. Associate’s degree preferred.

Experience

• Two years of medical billing experience
• One year experience with electronic billing
• Epic experience desired

Knowledge, Skills And Abilities

• Thorough knowledge and understanding of medical billing, insurance and private pay
• Knowledge of all medical billing requirements for Medicare, Blue Cross, Medical Assistance, Commercial insurance, and HMO carriers
• Strong collection skills, including claims follow-up, revenue cycle practices
• Strong computer skills, including EMR knowledge and Microsoft Office. Excel preferred
• Strong interpersonal skills
• Excellent verbal and written communication skills for interacting with patients, families, insurance companies and healthcare providers
• Strong 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
• Licenses, Certifications: N/A

Principal Duties And Responsibilities

• Manages assigned Epic work queues daily to ensure accurate billing and expedient claims follow-up
• Claims Billing Processes
• Timely submission of all claims within assigned financial classes
• Timely follow up of all claims within assigned financial classes
• Claim Resolution Processes
• Investigates claim denials or rejections
• Completes functions in order to resolve claims
• Uses all available tools such as but not limited to: Online access, calling the insurance companies; working with provider representatives
• Identifies appeals
• Identifies secondary billing for accounts with secondary liability; follows-up on any unpaid balances
• Bills timely to patient/family. Follow-ups as necessary including calling for follow up
• Enters and posts payment to patient accounts based on remittance advice review
• Reconcile accounts and ensure any underpayments or overpayments are corrected
• Responds to patient and third-party payor inquiries regarding patient accounts via e-mail, telephone, mail, and in person
• Audits primary patient bills for submission to third party payers via electronic billing or manual claim submission
• Maintain detailed and accurate billing records for auditing purposes and compliance with industry regulations
• Maintain thorough records of all communication with insurance providers and patients regarding claims
• Participate in meetings with Provider Reps to resolve denial discrepancies
• Prepare and submit appeals for denied claims. Understands additional documentation necessary to submit an appeal
• Obtain an in-depth understanding of hospice billing regulations. Ensure compliance with federal, state and local billing laws, including HIPAA regulations
• Prepare reports to managers recommending accounts for bad debt adjustments
• Maintain lost revenue at a level of less than 1% of net healthcare revenue
• Recommends accounts for transfer to bad debt

Physical Requirements

• Sit, concentrate and pay close attention to detail

Working Conditions

• Normal office environment with little exposure to excessive noise, dust, temperatures and the like

Conditions Of Employment

• N/A

GBMC Values

• Respect: Treats everyone with courtesy. Fosters a healing environment. Treats others with fairness, kindness, and respect for personal dignity and privacy. Listens and responds appropriately to others’ needs, feelings, and capabilities. Recognizes and celebrates the accomplishments of others. Meets and/or exceeds customer expectations. Actively pursues learning and self-development. Pays attention to detail; follows through
• Excellence: Strives for superior performance in every aspect of work. Recognizes and celebrates the accomplishments of others. Actively pursues learning and self-development. Pays attention to detail; follows through. Sets a positive, professional example for others. Takes ownership of problems and does what is needed to solve them. Appropriately plans and utilizes required resources for various job duties. Reports to work regularly and on time. 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
• Accountability: Acts professionally in the way one acts, looks, and speaks. Takes ownership of problems and does what is needed to solve them. Sets a positive, professional example for others. Appropriately plans and utilizes required resources for various job duties. Reports to work regularly and on time. 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
• Teamwork: Engaged and collaborative. Keeps people informed. 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. Protects the patient. Adapts to changes 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
• Pay Range
• $19.92 - $29.87
• Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.

Equal Employment Opportunity

• GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.