GIRMC Hospital Billing Specialist

About the Role

Responsible for the accurate submission of claims to Medicare, Medicaid, and all third-party payers according to GIRMC compliance policies and federal billing regulations to ensure timely and accurate payment. This role handles claim re-submissions, re-works, communications, reconsiderations, and appeals, while supporting Medical Center compliance standards. Works closely with Medical Center personnel, medical staff, payer contacts, outside agencies, patients, and family members as needed.

Responsibilities

• Reviews and analyzes erred claims for correct and complete patient and insurance information, service dates, and charges.
• Ensures all billing forms are completed accurately based on billing regulations for all payers to maintain compliance and timely reimbursements.
• Analyzes outstanding unbilled claims and reports concerns to management.
• Maintains knowledge of current billing guidelines and third-party payer regulations.
• Processes returned claims, rework requests, and files resubmissions or appeals as necessary.
• Reviews assigned credit balances for appropriate refund or adjustment processes and disputes refund requests when necessary.
• Reviews work queues for insurance updates, applies appropriate coverages to patient visits, and ensures billing accuracy, including accessing insurance websites and handling lengthy phone calls for claim disputes.
• Organizes and scans patient financial services documents.
• Performs timely follow-up on outstanding claims to ensure accurate reimbursement.
• Works claim edits and rejections daily to ensure timely and accurate reimbursement.
• Investigates errors by communicating with department personnel and makes necessary system corrections.
• Actively researches State and Federal regulations and billing guidelines to ensure compliance.
• Reviews late charges/credits and requests claim re-bills where appropriate.
• Contacts patients or employers for correct health plan information via calls or correspondence, following GIRMC protocols for patient information release.
• Communicates new processes or changes in Medicare, Medicaid, and third-party billing requirements to co-workers, including legal compliance updates.
• Answers patient inquiries regarding itemized billing statements, insurance updates, and billing accuracy.
• Retrieves and resolves daily voicemails and emails from GIRMC Patient Accounts.
• Processes patient payments for Meditech accounts and payment plans.
• Works directly with collection agencies on bad debt accounts.
• Reviews billing statements from Meditech for errors.
• Works daily in Electronic Medical Record (EMR) systems and the Assurance system for claim submission.
• Maintains professional growth through seminars, workshops, and professional affiliations.
• Participates in meetings, committees, and department projects as assigned.
• Performs other related projects and duties as assigned.

Requirements

• High school diploma or equivalency required.
• Associate’s degree in business or accounting-related field preferred.
• Two (2) years’ experience in patient billing or other medical-related patient accounts experience required.
• Experience as a governmental biller in a hospital setting preferred.
• Training or prior experience in CPT/ICD-10 coding desired.
• Must be at least 19 years of age to witness legal consents.