GENERAL DESCRIPTION: To conduct appropriate billing and collection activity directed toward insurance carried and third party payers in a timely manner. To ensure consistent levels of cash flow for Warren General Hospital.

JOB DUTIES:

• Possess working knowledge of the Meditech B/AR and ADM application and other electronic claims tracking systems to access demographic, financials and insurance information to conduct collection activity on unpaid claims over 30 days
• Reviews the daily claim forms for appropriateness of charges and coding referring discrepancies to appropriate department or Patient Account Manger if necessary
• Edits and corrects daily claim forms for completeness and accuracy of payer-required detail
• Monitors primary and secondary billing sequences to ensure compliance with written procedures and third party billing
• Validates billing data in electronic clearing house database prior to electronic transmission to payers
• Enters billing data into database of electronic clearinghouse as needed
• Process late charges not submitted on original claim submission
• Timely processes EOB's and Remittance Advice(s) on a daily basis
• Processes sequential billing of claims after the primary insurance payment received
• Coordinates with insurance carriers and third party payers to get resolution of pended and inappropriately denied claims. Responsible for appealing inappropriate denials in writing and notifying PA Department of Insurance when they payer fails to meet contractual obligations
• Monitor hold and reject buckets in Clearinghouse on a daily basis to send out claims that have been corrected and are ready for claim submission
• Researches and coordinates the gathering and submissions of additional requested information from third party payers
• Documents finding in BAR, Process Accounts, Comments
• Responsible for maintain A/R days for designated insurance(s) within established industry standards
• Responsible for reporting issues/ problems related to Meditech Clearinghouse and payer(s)
• Review and researches overpayments weekly to resolve credit balances
• Responds to verbal and written inquires from patients, family members, insurance companies, employers and other parties regarding charges or billing issues per WGH's HIPPAA policies

REQUIREMENTS:

• High School Diploma or equivalent
• Certified Revenue Cycle Specialist- Institutional (CRCS-I) with 18 months of acceptance into the position
• Two years, or more, of healthcare related billing, coding and collection experience

Job Type: Full-time

Pay: From $20.58 per hour

Benefits:

• Dental insurance
• Employee discount
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work setting:

• Hospital

Education:

• High school or equivalent (Preferred)

Experience:

• inpatient, medical billing: 2 years (Preferred)

Work Location: In person