Our Billing Specialist analyzes, investigates, and resolves claims/billing information and/or errors associated with inpatient and outpatient claims. Ensures compliance with required guidelines and Memorial Health organizational policies.

Education:

• High school or GED equivalent required.

Experience:

• Previous experience with insurance billing and software (CPSI and NEBO) highly preferred.

Other Knowledge/Skills/Abilities:

• Familiarity with medical terminology, medical procedural (CPT) and diagnosis (ICD-9/10CM) coding and hospital billing claims form UB-04 highly preferred.
• Basic working knowledge of personal computers and their associate user software required.
• Experience with Microsoft Office products Word and Excel is preferred.
• Ability to work on multiple responsibilities simultaneously.
• Ability to work successfully with internal customers and external contacts.
• Highly developed critical thinking and problem solving-ability to work through complex situations.
• Excellent oral and written communication, keyboarding, and basic math skills and problem solving skills.

• Utilizes electronic software or by telephone to determine insurance eligibility and coverage for inpatient and/or outpatient claims.

• Creates and examines daily listings for assigned billing claims and determines which require further analysis action.

• Investigates assigned billing claims with incomplete/incorrect information and resolves problems or errors to ensure complete and complaint information accompanies the claim.

• Follows up and investigates unpaid items and other issues associated with unpaid claims. Contacts patients, guarantors or other sources of third party payment and secures arrangements for prompt payments.

• Analyzes reports containing rejected account information, and performs the necessary research to resolve the reason(s) for the rejection and secures any other required information.

• Responds to request from internal departments regarding the proper coding, billing and processing of insurance claims.

• Processes and post electronic vouchers from designated insurances.

• Communicates and resolves issues with a variety of internal and external sources to resolve issues involving medical insurance claims. This may include internal department, patient (or other responsible parties), third party payors, social service agencies and collection agencies.

• Provides input regarding system edits designed to identify and ensure consistent and complaint data necessary for processing medical insurance claims.

• Initiates corrections to charges and contractual allowances within scope of expertise and authority granted.

• Identifies accounts that require secondary billing and processes accordingly.

• Identifies and calculates write-off amounts and secures the necessary approvals from management for processing.

• Identifies accounts that require insurance pre-certifications and communicates with the insurance companies accordingly.

• Ensures compliance to managed care contract guidelines and processes at each work step to facilitate accurate and timely reimbursement to the organization.

• Documents online systems and electronic files to ensure accurate data is noted regarding the status of claims and payments.

• Performs other related work as required or requested.