Billing Specialist I - PB

Phelps Health

3d•Onsite

About The Position

The Billing Specialist I is responsible for collecting and entering claims, posting insurance, submitting claims, and answering patient inquiries on accounts. This role reports to the Billing Supervisor.

Requirements

High School Diploma or GED required.
Medical billing experience highly preferred.
Experience in billing software and electronic data submission preferred.
Ability to receive and express detailed information through oral communications, visual acuity, and the ability to read and understand written directions.
Normal mental concentration with repetitive operations for a long period of time.
Ability to stand, walk, sit, and reach.
Occasionally lifts and transports items weighing up to ten (10) pounds.

Responsibilities

Enters information necessary for insurance claims such as patient, insurance, and insurance ID, ensuring claim information is complete and accurate.
Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper UB04 and/or CMS-1500 form.
Answers patient questions on patient responsible portions, copays, deductibles, write-offs, etc., and resolves patient complaints or explains why certain services are not covered.
Follows up with insurance companies on unpaid or rejected claims, resolves issues, and re-submits claims.
Prepares appeal letters to insurance carriers when not in agreement with claim denial, collecting necessary information to accompany the letter.
Follows HIPAA guidelines in handling patient information.
May perform "soft" collections for patient past due accounts, which may include contacting and notifying patients via phone or mail.
Understands managed care authorizations and limits to coverage such as number of visits.
Verifies patient benefits eligibility and coverage as needed.
Prepares and submits secondary claims upon processing by primary insurer.