Billing Specialist (Hybrid)

DIGESTIVE HEALTH SPECIALISTS PA•Winston-Salem, NC

1d•Hybrid

About The Position

Responsible for the reimbursement and/or resolution of patient insurance account balances with the goal of working accounts to resolution. This role performs account management and analysis; as well as complete, timely and accurate follow up of insurance (hospital, physician or ASC) account balances with the objective of optimizing insurance reimbursement.

Requirements

High school diploma or equivalent
3-5 years medical billing experience required
CPB preferred or equivalent experience with advanced knowledge of medical terminology, ICD 10, CPT/HCPCS codes and HIPAA laws.
Ability to interpret EOBs and navigate insurance policies.
Proficient in Epic Resolute Billing
Well-organized with attention to detail
Proficient with technology, spreadsheet management skills with the ability to analyze trends.
Excellent organizational skills, ability to manage multiple priorities and responsibilities.
Ability to establish and maintain effective working relationships with team members, clinic staff and patients
Have a desire and dedication to work with self-discipline
Maintains the strictest confidentiality: adheres to all HIPAA guidelines and regulations
Ability to sit for long periods.
Work required walking, bending, standing, sitting, and reaching

Responsibilities

Maintain a professional and compassionate demeanor in all interactions with our patients.
Work all insurance follow up (hospital, physician and ASC), which includes a focus on claims that have been denied, need more information or are paid incorrectly by insurances.
Interacts with, and leverages, external and internal resources to overcome barriers, problem solve and ultimately resolve insurance account balances.
Communicate effectively with patients, physicians, contracted insurances and third party payers.
Review and determine appropriate actions for claim follow up, including but not limited to, appeals, insurance website inquiries, calls to insurance customer service representatives, etc.
This role is accountable for understanding and reconciling insurance practices such as: confirming a claim has been received, validation of denied charges, and collaboration with site resources to ensure denials are appealed timely and submitting information requested by insurance companies for denied claims.
Updates insurance information and routinely adds account notes to each account worked.
Identify questionable accounts/bills, problematic payers or unusual situations and brings to the RCM.
Identify and escalate any payer trends identified to resolve and/or mitigate issues.
Provide feedback to the RCM to address any issues related to insurance reimbursement and claims resolution.
Update personal job knowledge by participating in educational opportunities; reading professional publications, etc.
Possesses a thorough knowledge of DHS billing procedures, payer policies, CMS guidelines and general compliance principles.
Abides by all DHS policies and procedures and maintains excellent attendance.
Perform other duties as needed or assigned by Revenue Cycle Manager.