Insurance Billing Specialist

To submit health insurance claims to payers and collect on accounts.

ESSENTIAL FUNCTIONS AND BASIC DUTIES:

Supervisory-Specific Performance Expectations, Duties, and Responsibilities:

oN/A

Position-Specific Performance Expectations, Duties, and Responsibilities:

oProcess and submit health insurance claims to various insurance companies in a timely and accurate manner.

oEnsure claims are coded correctly in compliance with the latest medical coding and billing guidelines (CPT, ICD-10, HCPCS).  Collaborate with the coding and clinical departments to resolve edits and denials.

oMaintain a working knowledge of Medicare and Medicaid as well as commercial payer guidelines, and stay abreast of new policy changes.

oVerify patient eligibility and coverage details before claim submission, and reconcile coverage denials when necessary.

oResolve claim edits both in the electronic medical record and in the clearinghouse to prevent denials.

oFollow up with insurance companies regarding denied or underpaid claims, and submit appeals when appropriate.

oReview insurance and patient credit balances and resolve them timely.

oEducate patients on their billing inquiries, providing clear and accurate explanations regarding their insurance coverage and payment responsibilities.

oDocument all actions taken with an account in the electronic medical record (EMR).

oPerforms other duties as assigned.

Organization-Specific Performance Expectations, Duties, and Responsibilities:

oDemonstrates 100% commitment to performance in accordance with the CHOICE values of MRH and representing the organization in a positive and professional manner.

oEstablishes and maintains effective verbal and written communication and good working relationships with all patients, staff, and vendors.

oAdheres to MRH attire/dress code per policies and procedures.

oUtilizes initiative; strives to maintain a steady level of productivity; self-motivated; and manages activity and time.

oCompletes annual education, training, in-service, and licensure/certification requirements; and attends departmental and organizational staff meetings or reads meeting minutes.

oMaintains patient confidentiality at all times.

oReports to work on time as scheduled; completes work within designated timeframes.

oActively participates in departmental and organizational performance improvement and continuous quality improvement activities.

oStrives to uphold regulatory requirements to ensure continual compliance with departmental, hospital, state, and federal regulations and policies.

oFollows policies and procedures for infection control, safety, and risk management to ensure a safe environment for patients, the public, and staff.

QUALIFICATIONS:

Minimum Requirements:

oMust be at least 16 years of age (21 for driving positions with a valid driver’s license).

oMust be able to legally work in the United States.

oMust be able to pass a background check.

oMust be able to pass a drug screen and breath alcohol test (if applicable).

oMust complete employee health meeting.

Required Education/Licensure/Certification:

oMedical billing or coding certification highly desired (CPC, CPB, RHIT, CCS, etc.).

oHigh School Diploma or equivalent, preferred.

Experience:                                                                         

oTwo (2) years prior experience in medical billing, accounts receivable, or related field required (can substitute with a medical billing or coding certification (CPC, CPB, RHIT, CCS, etc.).

oKnowledge of UB-04 and CMS-1500 claim forms, preferred.

oEpic or similar EMR experience, preferred.

oPrior authorization process experience, preferred.

oTyping speed of a minimum of 30 WPM, preferred.

oProficiency in Excel, preferred.

• Position Classification:  Non-Exempt

  Compensation Range: $25.04 to $37.56

  Benefits:  Medical, Dental, Life, Retirement, Paid Time Off

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