Billing Specialist

Billing Specialist

Under general supervision, is responsible for representing Roosevelt General Hospital and RGH Clinic as an exemplary hospital in the region. The Billing Specialist position requires fundamental knowledge of filing insurance claims on UB and HCFA claim form, how insurance companies pay accordingly to contracts established with the hospital, how to read and interpret an insurance explanation of benefits (EOB), process denials, import charges and do precise follow-up with the insurance company via phone, email, insurance websites, etc. at an acceptable volume per day. The Billing Specialist will be the embodiment of the hospital's mission, vision and values. The Billing Specialist will greet patients or family members upon arrival within the business office and assist them in answering any questions or concerns they may have regarding billing issues. The Billing Specialist will have knowledge of all aspects of the department process from the registration through the billing process.

Promote the mission, vision, and values of the organization

• Responsible for all billing functions for assigned financial class(es).
• Account checks must be worked daily
• Tasks must have less than 5% overdue at month end
• Denials must have less than 5% overdue at month end
• Credit Balances must be addressed within 2 weeks of initiation by adjusting contractual allowances, submitting refund request, or submitting claim cancellation
• Incomplete claims (FinThrive) must obtain necessary billing information to submit claim
• Incomplete claims (FinThrive) must be worked daily
• Rejections (FinThrive) must be worked daily
• Held Claims (FinThrive) must be updated every 2 weeks

Assist patients with billing inquiries to include explaining the charges, payments, insurance decisions, insurance coverage, coordination of benefits, or any other concerns they may have

Respond to voicemails within 24 business hours

Maintain active portal accounts to all assigned payors

Communicate directly with payor or provider representatives when recurrent issues arise

Release medical records upon request within 3 days of receipt

Follow up on any correspondence that may have been received weekly

Submit revised order requests for accounts that meet criteria

Participate in weekly billing huddles/discussions

Participates in data gathering for financial reporting

Cross train in other Billing Specialist positions to include different payers

Report frequent billing issues to Billing Lead/Director of Business Office to determine if permanent resolution is available through software systems

High school graduate or equivalent

Six months previous hospital registration, billing and collections, financial counseling, and/or customer service experience required

Medical terminology knowledge preferred.

Basic computer knowledge

Typing speed: minimum 40 wpm, computer knowledge

Knowledge of CPT / ICD- coding helpful.

Adhere to dress code, appearance is neat and clean.

Complete annual education requirements.

Maintain patient confidentiality at all times.

Report to work on time and as scheduled.

Wear identification while on duty.

Maintain regulatory requirements, including all state, federal and local regulations.

Represent the organization in a positive and professional manner at all times.

Comply with all organizational policies and standards regarding ethical business practices.

Communicate the mission, ethics and goals of the organization.

Participate in performance improvement and continuous quality improvement activities.

Attend regular staff meetings and in-services.

Knowledge of medical insurances (Medicare, HMO's, PPO's, commercial), EMTALA regulations, hospital billing and collection process

Must have an enthusiastic and positive attitude

Possess a genuine desire to help RGH become an exemplary hospital in the surrounding community and the state

Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude

Ability to manage multiple and simultaneous responsibilities and to prioritize duties/tasks

Ability to initiate communication with patients, their families and hospital visitors

Must have excellent customer service and communication skills with the ability to effectively calm patients and be able to deal with distressed and/or agitated patients and their families

Must have a professional demeanor and excellent public relations skills

Willingness to develop or improve public speaking skills

Must have excellent written skills with knowledge of medical terminology

Must be dependable and on time

Possess good 'people skills' for building relationships with colleagues at all levels

Ability to plan and prioritize workload to meet deadlines

Work is performed during regular work hours, but may require overtime and/or weekend hours to meet deadlines

Work in varying degrees of temperature (heated or air conditioned)

Work under extreme pressures

Position requires sitting for approximately 4-8 hours per day with walking up to for 2 hours per day

Position requires light to moderate work with 50 pounds maximum weight to lift and carry

Position requires reaching, bending, stooping, and handling objects with hands and/or fingers, talking and/or hearing, and seeing