Billing Specialist

Memorial Health System•Springfield, IL

24d•$18 - $28

About The Position

Analyzes, investigates, and resolves claims/billing information and/or errors associated with the moreplex inpatient/outpatient medical insurance claims. Ensurespliance with managed care guidelines and MMCanizational policies. Embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision and values.

Requirements

Education equivalent to graduation from high school or GED is required.
Two or more years as a Billing Specialist (orparable medical claims/billing experience), with the technical knowledge to process all types of applicable claims and resolve errors andplex issues associated with them.
Demonstrates thorough knowledge of medical terminology, medical procedural (CPT) and diagnosis (ICD-9 CM) coding, and hospital billing claim form UB04 is required.
Demonstrates aprehensive knowledge of the electronic billing system and key contract billing guidelines and possess the ability to train others on the entire billing process.
Basic working knowledge of personalputers and their associate user software is required.
Ability to work within the guidelines of defined managed care contract policy provisions andpany procedures.
Demonstrates ability to work successfully with internal customers and external contacts is required.
Possesses a highly-developed detail orientation, critical thinking, and problem solving ability.
Demonstrates excellent oral and writtenmunication, keyboarding, and basic math skills.
Demonstrates ability to work unsupervised as well as the ability to work in a group setting.

Nice To Haves

Experience with Microsoft Office products Word and Excel is preferred.

Responsibilities

Receives and examines daily listings for assigned billing claims and determines which require further analysis and action.
Investigates assigned billing claims with iplete/incorrect information and resolves the moreplex problems or errors to ensureplete andpliant information apanies the claim.
Prioritizes claims based on specified criteria and files the claim, either electronically or via paper claim. Ensures careful adnce to insurance guidelines, timeliness, accuracy, and processing procedures.
Researches and resolvesplex issues associated with patient insurance accounts. As applicable, identifies, documents, and reports problematic trends to management.
Embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision and values: SAFETY: Prevent Harm - I put safety first in everything I do. I take action to ensure the safety of others. COURTESY: Serve Others - I treat others with dignity and respect. I project a professional image and positive attitude. QUALITY: Improve Oues - I continually advance my knowledge, skills and performance. I work with others to achieve superior results. EFFICIENCY: Reduce Waste - I use time and resources wisely. I prevent defects and delays.
Analyzes reports containing rejected account information and performs the necessary research to resolve the reason(s) for the rejection and secures any other required information.
Provides input regarding system edits designed to identify and ensure consistent andpliant data necessary for processing medical insurance claims.
Responds to requests from internal departments regarding the proper coding, billing, and processing of medical insurance claims.
Communicates and resolves issues with a variety of internal and external sources regarding medical insurance claims. This may include internal departments, patients (or other responsible parties), third-party payors, social service agencies, Medicare/Medicaid staff, other insurance carriers, service providers, and collection agencies.
Initiates corrections to charges and contractuals / allowances within scope of expertise and authority granted.
Identifies and researches the appropriateness of late charges and, as necessary, adjusts the charge / patient account based on research findings
Identifies and calculates write-off amounts and secures the necessary approvals from management for processing.
Documents online systems and electronic files to ensure accurate data is noted regarding the status of claims and payments.
Ensurespliance to managed care contract guidelines and processes at each work step to facilitate accurate and timely reimbursements to theanization.
May assist with special projects, analyses, or audits.
As directed and defined by management, orients and cross-trains on other unit duties which are outside of regularly assigned area of responsibility. May serve as a back-up for other areas within the unit or department, especially during times of special needs or staff absences.
Performs other related work as required or requested.