Billing Specialist

Summary Under general supervision of the Billing Manager, performs insurance/billing clerical duties, including review and verification of patient account information against insurance program specifications. Resolves routine patient billing inquiries and problems, follows up on balances due from insurance companies, and types invoices to insurance companies. Enters data electronically to process charges, payments, denials, and adjustments. Analyzes surgical procedures and diagnoses using ICD‑9 and CPT‑4 codes. Responsible for compliance related to third‑party billing and analyzes and resolves medical necessity issues. Brown University Health employees are expected to role‑model the organization’s values of Compassion, Accountability, Respect, and Excellence. 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. 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. Calculate bills manually using detail bills. Enter, edit, and view claims in system, including review and verification of patient account information against insurance program specifications. Identify source of entry in a complex multi‑facility organization. Analyze and resolve problems with coding of surgical procedures and diagnoses using ICD‑9, CPT‑4 and HCPC coding. Liaise with internal and external departments and attend meetings when necessary. Maintain productivity measures and accuracy standards defined by the department. Review reports, charts, records and/or bills prepared by others to ensure calculations are correct. Contact other departments or personnel as necessary to resolve errors and omissions. Download bills from mainframe system to claims editing system; translate claims, submit electronic and paper billing daily. Utilize a variety of systems necessary to resolve problems. Participate in educational programs and in‑service meetings. Operate standard and/or automated office machinery such as online computer terminal, calculator, fax machine, photocopier, and microfilm viewer. Participate in training of new employees. Maintain quality assurance, safety, environmental and infection control in accordance with established policies and procedures. Minimum Qualifications High School diploma with proficiency in use of MS Office 2000 or later, particularly Excel and Word. One to two years of experience in health care/patient accounting or a relevant setting; or equivalent combination of training and relevant work experience. Compensation 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 #J-18808-Ljbffr