Billing Specialist I

Medical Billing SpecialistUnder direct supervision, performs all billing and collection functions on account balances within assigned financial classes. Ensures timely submission of all claims and timely follow up. Posts payments in EPIC. Perform eligibility, verification and authorization requests, as needed.EducationHigh School diploma or equivalent required. Associate's degree preferred.ExperienceTwo years of medical billing experience and one year experience with electronic billing. Epic experience desired.Knowledge, Skills and AbilitiesThorough knowledge and understanding of medical billing, insurance and private pay.Knowledge of all medical billing requirements for Medicare, Blue Cross, Medical Assistance, Commercial insurance, and HMO carriersStrong collection skills, including claims follow-up, revenue cycle practicesStrong computer skills, including EMR knowledge and Microsoft Office. Excel preferred.Strong interpersonal skillsExcellent verbal and written communication skills for interacting with patients, families, insurance companies and healthcare providers.Strong ability to investigate issues, find solutions, and work under pressure to resolve billing issues.Efficient in managing multiple tasks, prioritizing, and ensuring deadlines are met.Ability to handle multiple claims and billing tasks simultaneously while maintaining quality and accuracyPrincipal Duties and ResponsibilitiesManages assigned Epic work queues daily to ensure accurate billing and expedient claims follow-up.Claims Billing ProcessesEnsures timely submission of all claims within assigned financial classes.Ensures timely follow up of all claims within assigned financial classesClaim Resolution ProcessesInvestigates claim denials or rejectionsCompletes functions in order to resolve claimsUses all available tools such as but not limited to: Online access, calling the insurance companies; working with provider representatives.Identifies appealsIdentifies secondary billing for accounts with secondary liability; follows-up on any unpaid balances. Brings these claims to resolution.Identifies patient self-pay balances and bills timely to patient/family. Follow-ups as necessary including calling for follow up.Process any late charge claims, claims resubmission and/or claims corrections to payors.Enters and posts payment to patient accounts based on remittance advice review.Reconcile accounts and ensure any underpayments or overpayments are correctedResponds to patient and third-party payor inquiries regarding patient accounts via e-mail, telephone, mail, and in person.Audits primary patient bills for submission to third party payers via electronic billing or manual claim submission.Maintain detailed and accurate billing records for auditing purposes and compliance with industry regulationsMaintain thorough records of all communication with insurance providers and patients regarding claims.Participate in meetings with Provider Reps to resolve denial discrepanciesPrepare and submit appeals for denied claims. Understanding of additional documentation necessary to submit an appealObtain an in-depth understanding of hospice billing regulations. Ensure compliance with federal, state and local billing laws, including HIPAA regulations.Prepare reports to managers recommending accounts for bad debt adjustments. Maintaining lost revenue at a level of less than 1% of net healthcare revenueRecommends accounts for transfer to bad debt.Physical RequirementsAbility to sit, concentrate and pay close attention to detailWorking ConditionsNormal office environment with little exposure to excessive noise, dust, temperatures and the likeConditions of EmploymentN/AAll roles must demonstrate GBMC ValuesGBMC ValuesValue DescriptionRespectI will treat everyone with courtesy. I will foster a healing environment.Treats others with fairness, kindness, and respect for personal dignity and privacyListens and responds appropriately to others' needs, feelings, and capabilitiesExcellenceI will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others.Meets and/or exceeds customer expectationsActively pursues learning and self-developmentPays attention to detail; follows throughAccountabilityI will be professional in the way I act, look and speak. I will take ownership to solve problems.Sets a positive, professional example for othersTakes ownership of problems and does what is needed to solve themAppropriately plans and utilizes required resources for various job dutiesReports to work regularly and on timeTeamworkI will be engaged and collaborative. I will keep people informed.Works cooperatively and collaboratively with others for the success of the teamAddresses and resolves conflict in a positive waySeeks out the ideas of others to reach the best solutionsAcknowledges and celebrates the contribution of othersEthical BehaviorI will always act with honesty and integrity. I will protect the patient.Demonstrates honesty, integrity and good judgmentRespects the cultural, psychosocial, and spiritual needs of patients/families/coworkersResultsI will set goals and measure outcomes that support organizational goals. I will give and accept help to achieve goals.Embraces change and improvement in the work environmentContinuously seeks to improve the quality of products/servicesDisplays flexibility in dealing with new situations or obstaclesAchieves results on time by focusing on priorities and manages time efficientlyPay Range$19.92 - $29.87Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.Equal Employment OpportunityGBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.