Billing Specialist

Insurance/Billing Clerk

Under general supervision of the Billing Manager, performs insurance/billing clerical duties, including review and verification of patient account information against insurance program specifications. May resolve routine patient billing inquiries and problems follow up on balances due from insurance companies, and type invoices to insurance companies. May enter data electronically to process charges, payments, denials and adjustments. May analyze surgical procedures and diagnosis using ICD-9 &CPT-4 codes. Responsible for compliance related to third party billing; analyzes and resolves medical necessity issues.

Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate.

Responsibilities:

• Review federal and state documentation for changes in billing regulations.
• Perform posting and/or reconciliation of numerical data or departmental and/or hospital accounting records.
• May process patient bills to various insurance companies and social welfare programs according to established billing procedures.
• Review patient accounting records and documents to verify accuracy of charges and third party information and initiate corrections.
• May calculate bills manually using detail bills.
• Performs insurance billing duties/enter/edit/view claims in system, including review and verification of patient account information against insurance program specifications. Ability to identify source of entry in complex multi facility organization.
• Analyze and resolve problems with coding of surgical procedures and diagnosis using ICD-9, CPT-4 and HCPC coding.
• Effective interpersonal and communication skills required. Self-driven, results oriented with positive outlook.
• Ability to develop and maintain effective working relationships with staff.
• Act as liaison and attend meetings with both internal and external departments when necessary to perform duties and aid in organization development.
• Maintain productivity measures and accuracy standards defined by department.
• Review reports, charts, records and/or bills that were prepared or assembled by others in order to ensure that calculations are correct. Contact other departments or personnel as necessary to resolve errors and omissions.
• May download bills from mainframe system to claims editing system; translate claims, submit electronic and paper billing daily. Utilize variety of system necessary to resolve problems.
• Participate in educational programs and in-service meetings.
• May operate one or more standard and/or automated office machinery such as on-line computer terminal, calculator, fax machine, photocopier, and microfilm viewer.
• May participate in training of new employees.
• Maintain quality assurance, safety, environmental and infection control in accordance with established policies, procedures and objectives.
• Perform other related duties as required.

Minimum Qualifications:

Basic Knowledge: High School diploma with proficiency in use of MS Office 2000 or later, particularly Excel and Word.

Experience: One - two years' experience in health care/patient accounting or relevant setting; or equivalent combination of training and relevant work experience.

Pay Range: $19.97-$32.96

EEO Statement: Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

Location: The Miriam Hospital - 164 Summit Ave Providence, Rhode Island 02906

Work Type: M-5 8-4:30

Work Shift: Day

Daily Hours: 8 hours

Driving Required: No