Hospital Billing Specialist / Revenue Cycle

Schedule: Monday - Friday, 8:00am to 4:30pm

At Children's, the region's only full-service pediatric healthcare center, our people make us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are supported and deeply valued. Opportunities for career growth abound as we grow our services and spaces, including the cutting-edge Hubbard Center for Children. Join our highly engaged, caring team-and join us in providing brighter, healthier tomorrows for the children we serve.

Children's is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.

A Brief Overview
The billing specialist ensures, through various activities, that claims are clean and should be paid promptly by insurers without requiring additional information. This staff member performs all claim submission activities, including verifying existing information is accurate, determining when additional data is needed, and collecting necessary details to ensure claims are complete. The billing specialist's activities result in claims that can be submitted to payers without further intervention.

Essential Functions

• Reviews and files all claims in accordance with Central Billing Office policies and procedures and to make sure that payer specific billing requirements are met.
  • Investigates any discrepancies and makes corrections where needed.
  • Corrects all accounts in error or on hold within established timeline of receipt.
  • Resolves bill holds on accounts.
  • Corrects discrepancies of patient demographic information and insurance eligibility.
  • Verifies and secures coverage for newborn accounts prior to claim submission.
  • Ensures late charges are filed per payer and timely filing guidelines; requests additional information from appropriate staff members when needed.
  • Detects any other issues that could affect payment; works with appropriate staff members in other departments to ensure claims are ready for billing.
  • Ensures export of daily electronic claims or hard copy mail and forwards to appropriate third party payers.
  • Prepares required medical records and/or post audit itemized statements for submission with claims.
  • Prepares secondary and tertiary billings, manually and electronically on UB04's and/or CMS 1500's for accurate reimbursement.
  • Resolves clearinghouse claim edits and rejections and/or directing to appropriate area for resolution, if appropriate.
  • Processes requests received from follow-up and denials management teams for additional claim handling.
• Identifies possible billing edits, denials, and rejection trends such as adjusted length of stay discrepancies, and reports findings to billing claim analyst and/or supervisor.
  • Assists with complex or escalated issues as necessary as directed by leadership
• Keeps current on payor requirements though workshops, newsletters, and websites.
  • Complies with Federal and State billing requirements. Also complies with Health Information Portability and Accountability Act (HIPAA) and Electronic Data Interface (EDI) transaction formats.
• Other duties as assigned by leader and organization.

Education Qualifications

• High School Diploma or GED equivalent Required

Experience Qualifications

• Minimum 1 years of experience working in healthcare related field, preferably with health insurance billing and reimbursement processes. Required

Skills and Abilities

• Organized, self-motivated, and able to work independently of direct supervision to carry out responsibilities
• Knowledge and ability to apply of general concepts and practices that relate to hospital and professional billing, collection and reimbursement, the healthcare field, and specific policies, standards, procedures and practices that pertain to the assigned functions.
• Ability to keep abreast of trends, developments and changing regulatory requirements that impact matters within designated scope of responsibility.
• Intermediate computer skills including the use of spreadsheet programs and word processing programs.
• Ability to demonstrate excellent interpersonal skills, demonstrating attention to detail and critical thinking skills within the context of the assigned functions, with a commitment to accuracy.
• Ability to troubleshoot, understand and/or adapt moderately complex oral and or written instructions/guidelines to diverse or dissimilar situations.

Children's is the very best for kids and the very best for your career! At Children's, we put YOU first so together, we can improve the life of every child!