When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
Identifies, reviews, and interprets third party payments, adjustments, and denials. Initiates corrected claims, appeals and analyzes unresolved third party and self-pay accounts, initiating contacts and negotiating appropriate resolution (internal and external) to ensure timely and maximum payment. Manually and electronically applies insurance payments and works insurance overpayments, credits and undistributed balances. Works directly with the Supervisor, Billing to resolve complex issues and denials through independent research and assigned projects.
Job Description:
Essential Responsibilities including but not limited to:
1. Monitors days in A/R and ensures that they are maintained at the levels expected by management. Analyzes work queues and other system reports and identifies denial/non-payment trends and reports them to the Supervisor, Billing.
2. Responds to incoming insurance/office calls with professionalism and helps to resolve callers’ issues, retrieving critical information that impacts the resolution of current or potential future claims.
3. Establishes relationships and maintains open communication with third party payor representatives in order to resolve claims issues.
4. Reviews claim forms for the accuracy of procedures, diagnoses, demographic and insurance information, as well as all other fields on the CMS 1500.
5. Reviews and corrects all claims/charge denials and edits that are communicated via Epic, Explanation of Benefits (EOB), direct correspondence from the insurance carrier or others and uses information learned to educate PFS and office staff to reduce future denials and edits of the same nature. Initiates claim rebilling or corrections and obtains and submits information necessary to ensure account resolution/payment
6. Identifies invalid account information (i.e.: coverage, demographics, etc.) and resolves issues.
7. Evaluates delinquent third party accounts and processes based on established protocols for review, payment plan or write-off.
8. Reviews/updates all accounts for write-offs and refunds.
9. Reviews and follows through on all insurance credit balances through take back initiation, refund initiation, and/or payment re-application.
10. Completes all manual and electronic insurance payment posting assignments per the turnaround standards. Reports unfinished assignments to the Supervisor, Billing.
11. Keeps informed of all federal, state, and managed care contract regulations, maintains working knowledge of billing mechanics in order to properly ascertain patients’ portion due.
12. Completes all assignments per the turnaround standards. Reports unfinished assignments to the Supervisor, Billing.
13. Handles incoming department mail as assigned.
14. Attends meetings and serves on committees as requested.
15. Maintains appropriate audit results or achieves exemplary audit results. Meet productivity standards or consistently exceeds productivity standards.
16. Provides and promotes ideas geared toward process improvements within the Central Billing Office.
17. Assists the Supervisor, Billing with the resolution of complex claims issues, denials, appeals and credits.
18. Completes projects and research as assigned.
Minimum Qualifications:
Education: High School diploma required
Licensure, Certification & Registration: Billing Certification preferred
Experience: 1-2 years of experience in billing or related field
Skills, Knowledge & Abilities:
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Knowledge of basic math and business procedures, normally acquired in high school, to analyze bills.
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Knowledge of third party payor reimbursement, eligibility verification process, and government and payor compliance rules.
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Ability to organize and plan tasks for timely completion.
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Good verbal and written communication skills.
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Use of CRT approximately 80-90% of time.
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Ability to operate business office equipment.
Preferred Qualifications & Skills:
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Bachelor’s degree preferred
Pay Range:
$21.00 – $28.26
The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.
