Billing Specialist I-Business Office-Miramar-FT-Days-MPG

Billing Specialist

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.

The Billing Specialist is responsible for resolving claim edits for payors using the knowledge of the appropriate billing form and billing guidelines as well as various insurance contracts and payment methodologies to ensure a compliant claim. Reviews the claims to confirm the correct insurance filling order to ensure the correct payment at the time of initial submission. Ensures compliant billing based on the Office of Inspector General (OIG), CMS, HIPPA and any specific payor regulation. Proactively works accounts to maximize accurate and timely submission of claims utilizing knowledge of all billing guidelines.

Responsibilities:

Resolves payor gateway rejections using payor systems (EDI) information and analysis of the claim issue - for Hospital billing.

Resolves error in claim edit work queues for accurate and timely submission of paper and/or electronic claims. Uses OIG, CMS and HIPPA guidelines to refer a claim to the appropriate department for review and resolution of the errors, as needed.

Resolves edits in charge review/charge router work queues to ensure complaint billing based on medical documentation - for Physician Billing.

Requests and submits appropriate medical records to selected insurance companies or Medicare either for initial billing requirements or to respond to Additional Documentation. Requests (ADR) for oncology services. Works with audit nurses on coordination of medical records and letter of medical necessity for a formal appeal.- for Hospital billing.

Enters all Recovery Audit Contractor (RAC) reviews into the third-party software. Requests medical records and coordinates the response to the RAC request.- for Hospital billing

Documents all billing activities in patient account record to accurately reflect what changes have been made to the claim/or insurance information. Identifies billing errors trends and directs these trends to management for review and/or resolution.

Creates and submits Part B only claim to Medicare for inpatient services when Medicare Part A benefits are exhausted. If another insurance is also available for billing, reviews and submits a claim for the non-covered Part A services to that payor for payment.- for Hospital billing.

Confirms and corrects patient insurance information by calling the guarantor and/or mail inquires for accident insurance, workman's comp, or other needed insurance information. Updates account with any discovered insurance and notates the account with the new insurance information. Applies the unsolicited 271 transaction to add the insurance to the account, when applicable. Applies the unsolicited 271 transaction to add the insurance, when applicable - for Hospital billing.

Resolves claims edits monthly for skilled nursing/long term care for accurate and timely submission of paper and/or electronic claims.- for Hospital billing.

Works in appropriate claim system for Medicare and Medicaid to resolve overpayments by the payor by updating claim information in their system. - for Hospital billing.

Reviews coding to ensure that the procedures coded are billable according to the regulations set by the different payors. Adds applicable billing modifiers, when needed. Resolves clearinghouse errors and resubmits the claim for processing. Bills secondary or tertiary insurance by interpreting the explanation of benefits (EOB) from the payor. Adjusts or bills late charge/credit replacement claims using insurance payment methodologies.

Competencies:

ACCOUNTABILITY, ACCURACY, ANALYSIS AND DECISION MAKING, BILLING, CUSTOMER SERVICE, PROBLEM SOLVING, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR

Education and Certification Requirements:

High School Diploma or Equivalent (Required)

Additional Job Information:

Complexity of Work: Requires excellent communication skills, critical thinking skills, decisive judgment and the ability to work with minimal supervision. Knowledge of UB04 and/or CMS 1500 form, billing guidelines, insurance contract and payment methodologies. Must be able to work in a stressful environment and take appropriate action. Required Work Experience: No prior experience required. For Hospital Billing, the knowledge of UB-04 and EPIC hospital billing experience preferred. For Physician Billing, the knowledge of CMS 1500 and EPIC professional billing experience preferred.

Working Conditions and Physical Requirements:

• Bending and Stooping = 0%
• Climbing = 0%
• Keyboard Entry = 80%
• Kneeling = 0%
• Lifting/Carrying 0 - 25 lbs Non-Patient = 60%
• Lifting or Carrying > 75 lbs Non-Patient = 0%
• Pushing or Pulling 0 - 25 lbs Non-Patient = 60%
• Pushing or Pulling 26 - 75 lbs Non-Patient = 0%
• Repetitive Movement Hand/Arm = 80%
• Repetitive Movement Foot/Leg = 0%
• Running = 0%
• Sitting = 80%
• Standing = 80%
• Walking = 80%
• Audible Speech = 80%
• Hearing Acuity = 80%
• Seeing - Far = 80%
• Seeing - Near = 80%
• Computer Monitor = 80%

Shift: Primarily for office workers - not eligible for shift differential

Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification. Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process. Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity. Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, gender identity or expression, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law. We are proud to offer Veteran's Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program. Employment is subject to post offer, pre-placement assessment, including drug testing. If you need reasonable accommodation during the application process, please call View phone number on click.appcast.io (M-F, 8am-5pm) or email View email address on click.appcast.io .