Senior Revenue Cycle Billing Specialist - FT - Day - Hospital Billing Lawrenceville NJ

About the role

The position acts as a front-line resource for staff inquiries, coaching, and training related to the healthcare claim submission life cycle. It supports billing management and work-focused projects, and provides feedback.

Responsibilities

• Acts as a resource for problem solving and education for Hospital Billing Revenue Specialists.
• Communicates effectively to Leadership and identifies opportunities for improvement.
• Supports department performance improvement initiatives.
• Assigns worklist to billing staff and helps maintain and drive productivity standards.
• Responsible for all claims submitted to payer.
• Analyzes claims for errors and makes corrections prior to submission.
• Analyzes claims for errors during all stages of submission for accuracy of billing.
• Maintains current knowledge of payer requirements.
• Demonstrates a comprehensive understanding of team functions and specialized terminology of third-party payers.
• Works closely with appropriate staff/departments to make corrections and ensures accuracy for the days’ work.
• Verifies covered days (hospital) and services to be rendered (hospital/professional) prior to submitting claims in a timely manner.
• Corrects errors from the daily claim (277) rejections or escalates to the appropriate department for resolution.
• Reviews hospital billing reports for corrections needed in order to have the accounts final bill.
• Evaluates, reviews, and analyzes patient accounts to determine if third party payments have been received, recorded, and are appropriate based on contractual expectations.
• Identifies and communicates payment variances, error trends, and account issues for resolution to management.
• Reviews credit balances for adjustments, refunds, or claim adjustment submissions as assigned.
• Researches and retrieves appropriate documentation (e.g., authorizations, medical records) for appealing denials.
• Works correspondence as assigned and escalated by correspondence team.
• Communicates denials and other issues with the appropriate Revenue Cycle department and/or physician representative to address root causes.
• Documents clear and concise notes in the billing system.
• Enters charges into Billing System from various reports, where relevant.
• Performs assigned worklists and other duties quickly and accurately showing attention to details and is sufficiently organized to produce quality work.
• Maintains assigned productivity standards and escalates obstacles in accomplishing expectations in a timely manner.
• Prioritizes and updates files and other required documentation in accordance with established policies, guidelines, and procedures.
• Demonstrates willingness to adapt to changing departmental demands as new billing duties are required.
• Completes special assignments and projects with minimal supervision and consistently meets targets.

Requirements

• Education: High school diploma or equivalent.
• Experience: Three years' previous healthcare billing experience in a hospital, professional, or medical office setting.

Qualifications

• Special Training: Intermediate knowledge of Microsoft office products, specifically word and excel. Proficient experience using Electronic Medical Record (EMR) software. Cerner, Athena, Epic preferred.

Skills

• Knowledge and Skills: Demonstrates a comprehensive understanding of team functions and specialized terminology of third-party payers.

Benefits

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