Ashe Memorial Hospital -posted 2 months ago
Full-time
Jefferson, NC
251-500 employees

At Ashe Memorial Hospital, we are driven by our Mission Statement, "To meet the needs of the community by delivering patient-centered, high quality health care." Ashe Memorial Hospital is proud to be Voted Ashe's Best Place to Work 2022, 2023, & 2024! Come be a part of our dynamic team; you'll join Ashe's 2022 & 2023 Best Hospital, Best Surgeon, Best Physician, Best Nurse, and Best Medical Practice! This is your opportunity to make a large difference in a small community! The Billing Specialist is responsible for the accurate and timely preparation, submission, and follow-up of electronic and paper medical claims to third-party payers. This role ensures compliance with payer-specific requirements and federal/state regulations, resolves claim edits and supports the revenue cycle team in achieving optimal reimbursement. The Billing Specialist is responsible for reviewing and resolving clearinghouse hold, error, and rejection lists. The Billing Specialist files primary, secondary, and tertiary insurance, rebills, and reviews payment remittances. Reviews claim rejections for possible correction and provide feedback to the appropriate department. Must be proficient in the use of multiple payor software systems and possess knowledge of billing coding, including CPT, ICD10, HCPCS, modifiers, CCI edits, MUE edits, and claims formats. The ultimate result of these efforts should facilitate complete and prompt payments from third party payors to ensure maximum cash flow. Interacts with patients and staff in a professional manner, promotes teamwork, and creates an environment where a positive patient experience is a requirement.

  • Prepare and submit clean claims electronically and via paper for assigned payers.
  • Review claims for accuracy, completeness, and compliance with payer guidelines.
  • Apply appropriate coding edits (CCI, payer-specific) and modifiers.
  • Correct and resubmit rejected or denied claims.
  • Correct and validate submission of claims to Medicare (DDE).
  • Respond to internal and external inquiries regarding billing and claims.
  • Ensure compliance with HIPAA, CMS, and payer-specific billing regulations.
  • Stay current with changes in billing rules, payer policies, and coding updates.
  • High school diploma or general education degree (GED) required.
  • 1 year of experience in computerized third-party billing of facility and/or professional services required.
  • Knowledge of third-party billing requirements required.
  • Post high school courses in insurance billing, data processing, and medical terminology preferred.
  • 2 years of previous hospital business office experience preferred.
  • 1 year of experience with Meditech and/or SSI preferred.
  • Benefits apply the 1st of the month following employment, per policy.
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