What are the responsibilities and job description for the Insurance Billing Specialist position at Shenandoah Medical Center?
1. Review and submit clean claim for payment
- Reviews and corrects all claim edits in the clearinghouse.
- Reviews and corrects all edits within the EMR software.
- Ensure proper secondary billing.
- Review and submit Paper claims with required attachments if appropriate.
- Verifies all unknown information with the appropriate department.
2. Process Medicare DDE.
- Review and correct all Medicare claim edits for submission to WPS.
- Review and correct all Return to Provider claims.
3. Completes Timely Follow-Up.
- Reviews account balances to ensure accuracy.
- Achieves department weekly goal for follow-up.
- Works with payers on denials with processes including, but not limited to, phone call verifications, medical records submission, reconsideration and appeals.
- Ensures the proper and timely submission of patient responsibility to statement vendor.
4. Completes Regular Review of Aging.
- Reviews aging reports on a regular basis.
- Completes frequent follow up on aged accounts.
- Reports issues to direct supervisor.
5. Performs other duties as assigned.
- Submission of reconsideration and appeals for payer denials as required.
- Completes and passed all training and exams.