Billing Specialist

Cheyenne Regional Medical Center•Cheyenne, WY

50d

About The Position

This position is responsible for the timeliness and accuracy of patient account billing and payer reimbursement by ensuring that coordination of benefits is accurate, and that payer reimbursement is appropriate as agreed upon in our organizational payer contracts. The Billing Representative provides outstanding customer service to our customers and payer sources.

Requirements

High school diploma (or Equivalent Certificate from an accredited program) or higher degree
Six (6) months of or more of customer service and/or monetary transaction experience
Knowledge and understanding of federal and state billing and coding regulations and compliance
Knowledge and understanding of HIPAA
Ability to multitask with a high attention to detail
Ability to type a minimum of 40 wpm
Ability to handle cash
Knowledge of medical terminology and coding

Nice To Haves

Completion of Billing/Coding Program with Certification
Healthcare and/or insurance billing experience
Home care billing experience

Responsibilities

Pursues and participates in education for assigned payer to remain current with changes in the healthcare industry via payer websites, payer newsletters, webinar and attendance at assigned payer meetings.
Reviews accounts each day in assigned Epic Work Queues and prioritize by dollar amount and timely filing rules to achieve the best possible reimbursement.
Completes necessary research to submit claims to appropriate payer based on coordination of benefits and active coverage at time service was rendered.
Evaluates payer remittance advice and/or explanation of benefits on denials for accuracy according to individual payer contracts.
Maintains knowledge of Medicare, Medicaid, and all commercial insurance programs, including Medicare HMO’s and State Programs to include filing deadlines, billing requirements, and reimbursement methods.
Composes and submits appeals to third party payers, appealing to the highest level to resolve account denial for proper reimbursement.
Receives and researches patient, payer, attorney, and third party inquire received through incoming calls and correspondence in a timely manner by reviewing all available information including payer remits, contracts, documentation, policies and procedures, and insurance laws to formulate an informative response and direct the account appropriately.
Maintains or exceeds performance metrics according to job assignment focusing on reduction to Accounts Receivable Days and Denial Rates.
Provides feedback to management on denial trends and claim edits to assist with process improvement and quality assurance within our billing software.
Provides exemplary customer service and demonstrate positive communication skills in a courteous, accurate and honest manner.