Role and Responsibilities The Billing Specialist position is a member of the Billing Team which reports up through the Finance Department. The Billing Specialist is responsible for bill file routing, uploading, error correction, and re-submission. Essential Functions
- Responsible for submitting and receiving all electronic claim files and payer response/rejection files, and for researching and re-submission of claims rejected by clearing house/payer.
- Work pre-post reports prior to submission to ensure claims are correct.
- Initiate and complete enrollment process for payers/providers in medical clearing house.
- Assist in adding and maintaining the HCHB payer setup process.
- Support, maintain, and administer multiple data systems for commercial insurances.
- Daily mapping, testing, processing, monitoring, logistics/order processing support, and reporting.
- Collaborate with manager and Billing Team to help complete billing claim workflows.
- Use appropriate documentation, reference materials, and/or websites to ensure that billing claims are processed accurately and efficiently.
- Monitor the number and types of claim rejections; resolve and report issues to Revenue Cycle Manager in order to ensure every service is billed accurately and timely.
- Assist in the development of a Billing Manual.
- Produce high quality work that is complete and accurate.
- Other duties as assigned.
This job description reflects management's assignment of essential functions; and nothing in this herein restricts management's right to assign or reassign duties and responsibilities to this job at any time. Education Requirements
- High School diploma or GED required.
- Associate's degree preferred.
Qualifications and Requirements
- Three to five (3-5) Years healthcare-related experience in billing, claims submission, or prior IT role.
- Team player mentality.
- Ability to work independently.
- Ability to organize, multi-task, and prioritize workload effectively.
- Must possess strong computer and communication skills.
- Understanding of HCPCS, ICD-10, and procedure codes.
- Demonstrated ability to maintain and protect confidentiality.
- Ability to read medical electronic claim file segments and loops.
- MS Office experience, especially Excel (2010+).
- Knowledge and understanding of Explanation of Benefits (EOB).
Work Environment The Billing Specialist is primarily in an office setting and may be exposed to outdoor conditions. The working conditions are classified as light work:
- Light work - Exerting up to 20 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Light work involves sitting most of the time.
Physical Requirements The following is a description of the physical requirements on a daily basis for the Billing Specialist. While performing the duties of the job the employee is regularly expected to:
- Stand
- Sit
- Hear
- Walk
- Talk
- Stoop or kneel
- Repetitive motion
This is not necessarily an exhaustive list of all responsibilities, duties, skills, efforts, requirements or working conditions associated with the job. While this is intended to be an accurate reflection of the current job, management reserves the right to revise the job or to require that other or different tasks be performed as assigned. EOE/AA Minority / Female / Disability / Veteran