Hospital Billing Specialist (Accounts Receivable)

Job Profile Summary

This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this role focuses on performing the following Billing related duties:

• Bills patients for administered care
• Handles incoming payments
• Calculates patient intake costs
• Tracks accounts receivable to ensure accuracy
• Works with patients to arrange special payment options when necessary

Responsibilities

The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.

• Performs day-to-day activity to ensure that all information for proper billing is complete and accurate; billing to assigned payers is transmitted or mailed within a timely manner.
• Conducts follow-up on outstanding account balances with assigned receivables and takes appropriate action for resolution.
• Responsible for researching and handling rejections, including understanding why a claim rejected, how it must be fixed, and what party is financially responsible. Must initiate any corrective action, including referral to the Team Lead or Supervisor when appropriate.
• Reviews, evaluates and processes appeals through research and resubmission to appropriate third party with complete and accurate supporting documentation.
• Resolves assigned accounts in a timely and accurate manner, maximizing reimbursement in compliance with assigned payer and government regulations, and provider organization and department policies and procedures.
• Maintains up-to-date knowledge of federal and state regulations and payer requirements along with annual updates to CPT/ICD-10 coding guidelines.
• Interacts daily over the phone, on the web and through correspondence with payers.
• Establishes working relationships with payer representatives to facilitate processing of claims.
• Regular interaction with other departments of the provider organization using electronic system tools to resolve accounts, including Patient Access, Revenue Integrity, Coding, Medical Records, Utilization Review, Hospital Departments, Physician’s Offices, and other administrative teams.
• Consistently achieves and maintains performance standards for assigned productivity, collections, and quality targets
• Identifies trends in workflows and rework and reports outstanding operational issues to management for further research and resolution.

Minimum Qualifications

• High school diploma or equivalent
• Two (2) years of experience in a medical billing and collection environment for a medical services provider and/or third-party payor

Preferred Qualifications

• Epic HB Billing, PB Billing or Insurance Follow-Up experience
• Completion of a medical terminology course and understanding of CPT and ICD diagnosis coding
• HFMA CRCR (Certified Revenue Cycle Representative)
• Epic certifications

Physical Requirements

• Work environment: professional office environment with typical office requirements such as computers, phones, photocopiers, filing cabinets, etc.
• Frequently required to speak, hear, communicate and exchange information
• Able to see and read computers displays, read fine print, and distinguish letters, numbers and symbols
• Occasionally lift and/or move up to 25 pounds
• Able to work in confined or open environments
• Able to work independently or in a team environment

Skills & Abilities

• Working knowledge of billing requirements for assigned payers and/or service specialties
• Ability to systematically analyze problems, draw relevant conclusions and devise appropriate course of action
• Ability to analyze data, perform multiple tasks and work independently
• Good interpersonal skills in written and verbal form are required
• Active communication and participation with email and meetings
• Tech-savvy with use of accounts receivables systems and related applications, email, and spreadsheets
• Proficient in using computers and navigating through third party application systems and web portals efficiently and effectively
• Ability to learn PC based computer systems, word processing, database and spreadsheet software programs
• Good interpersonal and communication skills and a basic understanding of team management concepts

Pay Range

$21.53 - $26.91