Patient Financial Services Senior Specialist - Hospital Billing
Job Description
Utilizes the Epic Hospital Billing System to review and monitor accounts through the Billing, Denial, & Follow-Up work queues. Investigate and resolve assigned accounts of the highest level of complexity (i.e., inpatient, high dollar, aged accts, etc.) within Hospital Billing, Denial, & Follow-Up various work queues to completion and communicate to the Manager within the designated time frame (essential).
Contacts insurance carriers or other responsible parties to determine what is needed for complete and accurate appeal documentation for a favorable outcome and follow through to time of payment posting.
Gathers all necessary documentation needed to have claims reprocessed/adjudicated. Informs and/or transfers to management of any problem accounts and or denial trends that require escalation within 2 days of identification.
Documents all actions taken within the EPIC account notes section and/or follow up/denial activities note sections. Adheres to all Hospital Billing, Follow up, and Denial departmental policies and procedures/training documents.
Completes necessary training sessions required for the Hospital Billing system and demonstrates good working knowledge from those sessions to successfully resolve assigned accounts within Follow Up and Denial work queues.
Performs Hospital Billing Revenue Cycle staff educational shadowing sessions pertaining to Hospital Billing operational policy and procedure workflow adherence upon Management request. Documents all inactive periods and makes them available upon management's request.
Solves accounts with the highest level of complexity in any Claims Edit work queue and resubmits claims through the Epic Billing System. Works assigned accounts with the highest level of complexity within claim edit work queue(s) daily and resubmit claims through the Epic billing system.
Solves accounts with the highest level of complexity containing External claim edits from Clearinghouse and resubmits claims through the Epic billing system.
Handles Paper claims processing including proper documentation of accounts with the highest level of complexity.
Communicates all claims/data problems to the Manager within one (1) day of identifying the issue(s).
Identifies and researches all incomplete or inaccurate information on claims, demonstrates proper handling and escalation as needed.
Handles payer 277 rejections on accounts with the highest level of complexity and resubmits claims through Epic Billing system or other means of submission (i.e., email, fax, payer portal, certified mail) and provides trends to management for payer outreach and/or internal billing system updates to ensure timely filing and reimbursement.
Education
High School Diploma / GED Required
Licensure, Certification & Registration
None Required
Experience
At least seven (7) years accounts receivable experience required
Skills, Knowledge & Abilities
- Demonstrates excellent attention to detail and prioritization of accounts
- Demonstrates strong working knowledge of Epic Hospital Billing Follow Up and Denial workflows, considered as Subject Matter Expert (SME) to team and other colleagues
- Demonstrates strong, clear oral and written communication
- Demonstrates strong professional telephone & email etiquette
- Demonstrates strong ability to interact with insurance carriers, patients, and co-workers in a professional and helpful manner
- Demonstrates excellent use of billing computer and PC skills
- Demonstrates a high level of problem solving and decision making skills
- Demonstrates a high level to resolve account issues to completion and obtain appropriate payment
- Demonstrates the ability to work independently and efficiently
Preferred Qualifications & Skills
- Experience in Revenue Cycle Accounts Receivable
- Experience working with EPIC Pay Range
- $23.00 - $30.95