Billing Specialist I

Under 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. Education High School diploma or equivalent required. Associate's degree preferred. Experience Two years of medical billing experience and one year experience with electronic billing. Epic experience desired. Knowledge, Skills and Abilities Thorough 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 carriers. Strong collection skills, including claims follow-up, revenue cycle practices. Strong computer skills, including EMR knowledge and Microsoft Office. Excel preferred. Strong interpersonal skills. Excellent 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 accuracy. Licenses, Certifications N/A Principal Duties and Responsibilities Manages assigned Epic work queues daily to ensure accurate billing and expedient claims follow-up. Claims Billing Processes Ensures timely submission of all claims within assigned financial classes. Ensures timely follow up of all claims within assigned financial classes. Claim Resolution Processes Investigates claim denials or rejections. Completes functions in order to resolve claims. Uses all available tools such as but not limited to: Online access, calling the insurance companies; working with provider representatives. Identifies appeals. Identifies 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. Processes any late charge claims, claims resubmission and/or claims corrections to payors. Enters and posts payment to patient accounts based on remittance advice review. Reconciles accounts and ensures any underpayments or overpayments are corrected. Responds 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. Maintains detailed and accurate billing records for auditing purposes and compliance with industry regulations. Maintains thorough records of all communication with insurance providers and patients regarding claims. Participates in meetings with Provider Reps to resolve denial discrepancies. Prepares and submits appeals for denied claims. Understanding of additional documentation necessary to submit an appeal. Obtains an in-depth understanding of hospice billing regulations. Ensures compliance with federal, state and local billing laws, including HIPAA regulations. Prepares reports to managers recommending accounts for bad debt adjustments. Maintains lost revenue at a level of less than 1% of net healthcare revenue. Recommends accounts for transfer to bad debt. Physical Requirements Ability to sit, concentrate and pay close attention to detail. Working Conditions Normal office environment with little exposure to excessive noise, dust, temperatures and the like. Conditions of Employment N/A Pay Range $19.92 - $29.87 Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs. Equal Employment Opportunity GBMC 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. #J-18808-Ljbffr Greater Baltimore Medical Center (GBMC)