Billing Specialist

Job Summary

Under general supervision, is responsible for representing Roosevelt General Hospital and RGH Clinic as an exemplary hospital in the region. The Billing Specialist position requires fundamental knowledge of filing insurance claims on UB and HCFA claim form, how insurance companies pay accordingly to contracts established with the hospital, how to read and interrupt an insurance explanation of benefits (EOB), process denials, import charges and do precise follow-up with the insurance company via, phone, email, insurance web sites, etc. at an acceptable volume per day.  The Billing Specialist will be the embodiment of the hospital’s mission, vision and values. The Billing Specialist will greet patients or family members upon arrival within the business office and assist them in answering any questions or concerns they may have regarding billing issues. The Billing Specialist will have knowledge of all aspects of the department process from the registration through the billing process.

Essential Job Responsibilities

• Promote the mission, vision, and values of the organization
• Responsible for all billing functions for assigned financial class(es). 
  1. Account checks
     • Must be worked daily 
  2. Tasks
     • Must have less than 5% overdue at month end
  3. Denials
     • Must have less than 5% overdue at month end
  4. Credit Balances
     • Must be addressed within 2 weeks of initiation by adjusting contractual allowances, submitting refund request, or submitting claim cancellation 
  5. Incomplete claims (FinThrive)
     • Must obtain necessary billing information to submit claim
     • Must be worked daily
  6. Rejections (FinThrive)
     • Must be worked daily 
  7. Held Claims (FinThrive) 
     • Must be updated every 2 weeks
• Assist patients with billing inquiries to include explaining the charges, payments, insurance decisions, insurance coverage, coordination of benefits, or any other concerns they may have
• Respond to voicemails within 24 business hours 
• Maintain active portal accounts to all assigned payors 
• Communicate directly with payor or provider representatives when recurrent issues arise 
• Release medical records upon request within 3 days of receipt
• Follow up on any correspondence that may have been received weekly
• Submit revised order requests for accounts that meet criteria 
• Participate in weekly billing huddles/discussions 
• Participates in data gathering for financial reporting
• Cross train in other Billing Specialist positions to include different payers
• Report frequent billing issues to Billing Lead/Director of Business Office to determine if permanent resolution is available through software systems

Non-Essential Functions

• Performs other duties as assigned.

Roosevelt General Hospital (RGH) is committed to providing safe, quality care to patients.  Employees are required to adhere to the Values of RGH.

Integrity 

• We are committed to honesty and ethical principles, where our words and actions reflect our dedication to fostering strong relationships and maintaining professional credibility. 
• We take accountability for our actions and their impact on others, consistently honoring our commitments and upholding moral standards and values in every situation. 

Learning 

• We promote personal growth and professional excellence by embracing continuous learning through training, mentorship, and constructive feedback. 
• We foster a collaborative culture driven by curiosity and critical thinking, encouraging staff to ask questions, seek answers, and share knowledge. 

Innovation 

• We confidently embrace changes in technology, processes, and practices, encouraging strategic risk-taking and creativity to enhance healthcare delivery, patient safety, and the quality of care. 
• We collaborate with partners from other hospitals, academic institutions, industry leaders, and community organizations to promote continuous improvement and remain at the forefront of advancing healthcare outcomes. 

Kindness 

• We engage in open communication with patients, families, and colleagues to understand their needs and concerns, while respecting their differences and upholding their dignity. 
• We foster a nurturing environment where individuals feel supported, understood, and valued, strengthening relationships, promoting growth, and enhancing the overall well-being of all. 

Excellence 

• We strive to be a model rural healthcare facility, setting high standards in healthcare delivery and ensuring exceptional patient satisfaction within the communities we serve. 
• We take pride in our accountability and fiscal responsibility, skillfully balancing costs and outcomes to guarantee that superior patient care is always delivered. 

Unity 

• We collaborate across departments and disciplines to deliver effective and compassionate healthcare, working alongside patients, families, and community partners to ensure seamless coordination of care and achieve our common goals of wellness and healing. 
• We prioritize open communication and mutual respect, empowering our teams to collaborate effectively by acknowledging and celebrating the unique contributions and strengths of each individual. 

Qualifications

• High school graduate or equivalent
• Six months previous hospital registration, billing and collections, financial counseling, and/or customer service experience required
• Medical terminology knowledge preferred.
• Basic computer knowledge
• Typing speed: minimum 40 wpm, computer knowledge 
• Knowledge of CPT / ICD- coding helpful.

Professional Requirements

• Adhere to dress code, appearance is neat and clean.
• Complete annual education requirements.
• Maintain patient confidentiality at all times. 
• Report to work on time and as scheduled.
• Wear identification while on duty.
• Maintain regulatory requirements, including all state, federal and local regulations. 
• Represent the organization in a positive and professional manner at all times.
• Comply with all organizational policies and standards regarding ethical business practices.
• Communicate the mission, ethics and goals of the organization.
• Participate in performance improvement and continuous quality improvement activities.
• Attend regular staff meetings and in-services.

Knowledge, Skills, and Abilities  

• Knowledge of medical insurances (Medicare, HMO’s, PPO’s, commercial), EMTALA regulations, hospital billing and collection process
• Must have an enthusiastic and positive attitude
• Possess a genuine desire to help RGH become an exemplary hospital in the surrounding community and the state
• Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude
• Ability to manage multiple and simultaneous responsibilities and to prioritize duties/tasks
• Ability to initiate communication with patients, their families and hospital visitors
• Must have excellent customer service and communication skills with the ability to effectively calm patients and be able to deal with distressed and/or agitated patients and their families
• Must have a professional demeanor and excellent public relations skills
• Willingness to develop or improve public speaking skills
• Must have excellent written skills with knowledge of medical terminology
• Must be dependable and on time 
• Possess good 'people skills' for building relationships with colleagues at all levels 
• Ability to plan and prioritize workload to meet deadlines

Physical Requirements and Environmental Conditions  

• Work is performed during regular work hours, but may require overtime and/or weekend hours to meet deadlines
• Work in varying degrees of temperature (heated or air conditioned)
• Work under extreme pressures
• Position requires sitting for approximately 4-8 hours per day with walking up to for 2 hours per day
• Position requires light to moderate work with 50 pounds maximum weight to lift and carry
• Position requires reaching, bending, stooping, and handling objects with hands and/or fingers, talking and/or hearing, and seeing