Billing Specialist

Roosevelt General Hospital•Portales, NM

About The Position

Under general supervision, is responsible for representing Roosevelt General Hospital and RGH Clinic as an exemplary hospital in the region. The Billing Specialist position requires fundamental knowledge of filing insurance claims on UB and HCFA claim form, how insurance companies pay accordingly to contracts established with the hospital, how to read and interrupt an insurance explanation of benefits (EOB), process denials, import charges and do precise follow-up with the insurance company via, phone, email, insurance web sites, etc. at an acceptable volume per day. The Billing Specialist will be the embodiment of the hospital’s mission, vision and values. The Billing Specialist will greet patients or family members upon arrival within the business office and assist them in answering any questions or concerns they may have regarding billing issues. The Billing Specialist will have knowledge of all aspects of the department process from the registration through the billing process.

Requirements

High school graduate or equivalent
Six months previous hospital registration, billing and collections, financial counseling, and/or customer service experience required
Basic computer knowledge
Typing speed: minimum 40 wpm, computer knowledge
Adhere to dress code, appearance is neat and clean.
Complete annual education requirements.
Maintain patient confidentiality at all times.
Report to work on time and as scheduled.
Wear identification while on duty.
Maintain regulatory requirements, including all state, federal and local regulations.
Represent the organization in a positive and professional manner at all times.
Comply with all organizational policies and standards regarding ethical business practices.
Communicate the mission, ethics and goals of the organization.
Participate in performance improvement and continuous quality improvement activities.
Attend regular staff meetings and in-services.
Knowledge of medical insurances (Medicare, HMO’s, PPO’s, commercial), EMTALA regulations, hospital billing and collection process
Must have an enthusiastic and positive attitude
Possess a genuine desire to help RGH become an exemplary hospital in the surrounding community and the state
Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude
Ability to manage multiple and simultaneous responsibilities and to prioritize duties/tasks
Ability to initiate communication with patients, their families and hospital visitors
Must have excellent customer service and communication skills with the ability to effectively calm patients and be able to deal with distressed and/or agitated patients and their families
Must have a professional demeanor and excellent public relations skills
Willingness to develop or improve public speaking skills
Must have excellent written skills with knowledge of medical terminology
Must be dependable and on time
Possess good 'people skills' for building relationships with colleagues at all levels
Ability to plan and prioritize workload to meet deadlines
Work is performed during regular work hours, but may require overtime and/or weekend hours to meet deadlines
Work in varying degrees of temperature (heated or air conditioned)
Work under extreme pressures
Position requires sitting for approximately 4-8 hours per day with walking up to for 2 hours per day
Position requires light to moderate work with 50 pounds maximum weight to lift and carry
Position requires reaching, bending, stooping, and handling objects with hands and/or fingers, talking and/or hearing, and seeing

Nice To Haves

Medical terminology knowledge preferred.
Knowledge of CPT / ICD- coding helpful.

Responsibilities

Promote the mission, vision, and values of the organization
Responsible for all billing functions for assigned financial class(es).
Account checks
Tasks
Denials
Credit Balances
Incomplete claims (FinThrive)
Rejections (FinThrive)
Held Claims (FinThrive)
Assist patients with billing inquiries to include explaining the charges, payments, insurance decisions, insurance coverage, coordination of benefits, or any other concerns they may have
Respond to voicemails within 24 business hours
Maintain active portal accounts to all assigned payors
Communicate directly with payor or provider representatives when recurrent issues arise
Release medical records upon request within 3 days of receipt
Follow up on any correspondence that may have been received weekly
Submit revised order requests for accounts that meet criteria
Participate in weekly billing huddles/discussions
Participates in data gathering for financial reporting
Cross train in other Billing Specialist positions to include different payers
Report frequent billing issues to Billing Lead/Director of Business Office to determine if permanent resolution is available through software systems
Performs other duties as assigned.