Hospital Billing Specialist

GENERAL SUMMARY:

The Hospital Billing Specialist (HBS) is responsible for the accurate submission of claims to Medicare, Medicaid, and all third party payers according to the Medical Center compliance policies and Federal billing regulations to ensure timely and accurate payment. In addition to submitting claims to primary payers, the HBS is responsible for claim re-submissions and re-works, claim communications, reconsiderations and appeals. The HBS ensures that Medical Center compliance standards are supported and works closely with Medical Center personnel, medical staff, payer contacts, outside agencies, patients and family members as needed.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

2. *Reviews and analyzes all erred claims for correct and complete patient and insurance information, service dates, and charges.

3. *Ensures all billing forms are completed and are accurate based on billing regulations for all payers to ensure appropriate and timely reimbursements are received and all compliance standards are maintained.

4. *Analyzes all outstanding unbilled claims and reports any concerns to the manager or director.

5. *Maintains knowledge of current billing guidelines and third party payer regulations.

6. *Responsible for processing returned claims and rework requests for information and filing resubmissions or appeals as necessary.

7. *Reviews assigned credit balances for appropriate refund or adjustment process and reviews refund requests from payer for a refund or appeal if BMC disputes the refund request.

8. *Reviews coverage manager for insurance updates; applies appropriate coverages to patient visits and ensure accuracy of billing.

9. Organizes and scans patient financial services documents.

10. Performs timely follow-up of all outstanding claims and takes the appropriate action to ensure accurate reimbursements.

11. *Works claim edits and rejections daily to ensure timely and accurate reimbursement.

12. *Investigates reason for errors by communicating with specified department personnel and makes the necessary corrections within the system. .

13. *Actively researches State and Federal regulations and billing guidelines to stay current to ensure compliance.

14. *Reviews late charges/credits; and where appropriate requests claim re-bill to complete billing process.

15. *Contacts patients or employers as necessary for correct health plan information by calling or sending correspondence as needed.

16. Acts as primary billing resource for assigned area; will cross-train with other billing areas.

17. Follows Medical Center protocols in communicating and releasing patient information.

18. Communicates new processes or changes in Medicare, Medicaid, and third party billing documentation requirements to co-workers, to include legal compliance information.

19. Performs other related projects and duties as assigned.

(Essential Job functions are marked with an asterisk "*").

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

1. Knowledge of patient accounting operations and standard techniques.

2. Knowledge of credit and collection practices, third party payer regulations and Joint Commission regulations.

3. Knowledge of federal, state and facility regulations including COBRA, HIPPA, Medicare, Medicaid and Corporate Compliance Plan.

4. Knowledge of billing and third party reimbursement websites for resource support and claim status updates.

5. Knowledge of computer hardware equipment and software applications relevant to work functions.

6. Ability to meet minimum productivity standards set forth by the department.

7. Knowledge of CPT and ICD-10 codes.

8. Ability to communicate effectively both verbally and in writing.

9. Ability to prioritize work demands and work with minimal supervision.

10. Ability to establish and maintain effective working relationships with all levels of personnel, medical staff, volunteer and ancillary departments.

11. Ability to maintain confidentiality relevant to sensitive information.

12. Knowledge of the Centers for Medicare and Medicaid Services (CMS), to include CCI, MUE, and OCE editing practices as they relate to government claims.

13. Hospital Billing Specialist is accountable for accurate claims that meet all State and Federal guidelines.

14. Strong analytical, problem solving, and communication skills.

15. Advances work knowledge by participating in continuing education in-services, webinars, teleconferences, Medicare and Medicaid seminars, reading periodicals/literature and seeking ongoing development opportunities.

16. Ability to react and effectively perform work under stressful situations.

17. Ability to maintain regular and punctual attendance.

EDUCATION AND EXPERIENCE:

High school diploma or equivalency required. Associates degree in business or accounting related field preferred. Two (2) years' experience in patient billing or other medical-related patient accounts experience required. Experience as a governmental biller in a hospital setting preferred. Training or prior experience in CPT/ICD-10 coding desired. Must be at least 19 years of age to witness legal consents.

PHYSICAL REQUIREMENTS:

(Physical Requirements are based on federal criteria and assigned by Human Resources upon review of the Principal Job Functions.)

(DOT)-Characterized as sedentary work requiring exertion up to 10 pounds of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body