Billing Specialist 2

Savista•Remote - OR, OR

15d•$16 - $23

About The Position

The Billing Specialist II is responsible for the timely submission of technical or professional medical claims to insurance companies. The role uses hospital and physician systems to verify patient, billing, and claim information; performs compliant primary, secondary, tertiary, and rebill billing; and submits claims electronically, on paper, or through payer portals. It also involves editing claims for compliance, updating patient demographics and insurance information, monitoring claims for missing information and authorization or control numbers, securing requested medical documentation, and resolving billing rejections. The specialist follows prioritization, timely filing, and notation protocols; communicates payer, system, and escalated account issues to management; responds to emails and telephone messages; and participates in meetings and training. Additional duties include importing verification and escalating import/export files, handling interim bills, overlap reviews, and money redistribution for correct claim creation, and maintaining patient confidentiality. The position adheres to professional standards, hospital policies, applicable laws and regulations, and JCAHO standards.

Requirements

At least 2 years of medical collections or billing experience.
Intermediate knowledge of ICD-10, CPT, HCPCS, and NCCI.
Intermediate knowledge of third-party billing guidelines.
Intermediate knowledge of billing claim forms (UB04/1500).
Intermediate knowledge of payer contracts.
Working knowledge of Microsoft Word and Excel.
Intermediate working knowledge of health information systems, such as EMR, claim scrubbers, and patient accounting systems.

Nice To Haves

Working knowledge of one or more patient accounting systems: EPIC, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts, or Paragon.
Working knowledge of the DDE Medicare claim system.
Knowledge of government rules and regulations.

Responsibilities

Use hospital and physician systems to verify patient, billing, and claim information for accuracy.
Perform compliant primary, secondary, tertiary, and rebill billing, including electronic, paper, and portal submissions to payers.
Edit claims to meet billing compliance guidelines for electronic and hardcopy submission.
Respond to emails and telephone messages in a timely manner.
Communicate payer, system, and escalated account issues to management.
Attend meetings, training seminars, and in-services as requested to develop job knowledge.
Adhere to professional standards, hospital policies and procedures, federal, state, and local requirements, and JCAHO standards.
Accept ownership of new and different requests and seek opportunities to add value to job accomplishments.
Update patient demographics and insurance information in appropriate systems.
Monitor claims for missing information, authorization, and control numbers (ICN/DCN).
Follow guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems.
Obtain medical documentation required or requested by third-party insurance carriers.
Maintain patient confidentiality in accordance with insurance collection guidelines and corporate policy and procedure.
Use provider billing manuals to obtain billing guidelines and requirements.
Verify imports and escalate import/export files.
Perform special handling billing, including interim bills, overlap review, and redistribution of money for correct claim creation.
Research and resolve billing rejections.