Billing Representative | Patient Financial Services

Insurance Claims Specialist

What You'll Do:

• Ensures insurance claims are sent timely and accurately to government, commercial and managed care plans, adhering to payer timely filing requirements
• Researches and resolves claim edits via Epic Work Queues (WQ) and/or external billing software, including electronic and paper processing
• Prepares and processes secondary and tertiary insurance claims completing coordination of benefit tables accurately reflecting prior payer reimbursement
• Ensures compliance and billing requirements for Worker's Compensation (WC) and third-party liability claims are met
• Ensures claims submission with all appropriate documentation, using the Release of Information (ROI) module in Health Information System (HIS)
• Verifies and updates patient account demographic and financial information, processing Real-Time Eligibility (RTE); contacting account guarantor and/or payer as appropriate for demographic and financial clarification
• Enters complete and appropriate account note(s) in HIS identifying actions taken to reconcile claims
• Works various hospital departments to insure all authorizations, coding and charge information is in place to expedite clams processing and accurate account reimbursement
• Works directly with Charge Description Master (CDM) Coordinator to insure all implanted devices are accurate and included on the claim
• Reviews Medicare Common Working File (CWF) to determine primary payer based on Medicare Secondary Payer Questionnaire (MSPQ), as appropriate.

Requirements

• High school diploma or equivalent and three (3) years' experience in the medical field preferably in a hospital setting. Knowledge of revenue cycle functions, understanding of health insurance and government programs, billing processes, managed care contracts, coordination of benefits with ability to interpret explanation of benefits desired. Knowledge of office practices and procedures, medical terminology and the ability to communicate effectively. Must be proficient with Microsoft Word, Excel and PowerPoint.

Shift: 1st

Hours: 80 per pay (Every two weeks)

Benefits

• Medical Insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• Flexible Spending Account

Time Off

• Vacation
• Sick Leave
• 11 Paid Holidays
• Personal Day

Retirement

• Ohio Public Employee Retirement System
• Deferred Compensation

Other

• Tuition Reimbursement
• Kidzlink Daycare Center
• Employee Recognition
• Free Parking
• Wellness Center
• Competitive Salaries
• Community/Family Atmosphere

Location:

• Approx. 25 minutes away from Dublin, OH
• Approx. 30 minutes away from Hilliard, OH
• Approx. 30 minutes away from Delaware, OH
• Approx. 30 minutes away from Powell, OH

We look forward to seeing your application!

It is our commitment to inclusivity and diversity and our ongoing determination to provide a welcoming and inclusive environment for all staff and guests of the Hospital, regardless of age, color, disability, gender, gender expression or gender identity, genetic information, national origin, race, religion, sexual orientation, or veteran status. For any questions or needed accommodations, please contact Memorial Health Human Resources.

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.