Billing Specialist

TYLER HOLMES MEMORIAL HOSPITAL•Winona, MS

About The Position

Job Summary: The Billing Specialist will be responsible for managing and processing Primary and Secondary claims in a timely manner, ensuring accuracy and compliance with regulations. They are responsible for appropriate follow-up of transmitted or mailed medical claims. This role requires strong analytical skills and the ability to communicate effectively with various stakeholders.

Requirements

Excellent Customer Service and Communication Skills
Strong Attention to Detail
Must be a detail-oriented multitasker who works well under pressure
Proven experience in billing, claims processing or a similar role
Strong understanding of medical billing codes and insurance policies
Strong analytical and problem-solving skills
Effective communication and interpersonal skills, is empathic, listens for understanding and has pleasant telephone presentation skills
Has excellent organizational skills. Organize and prioritize tasks to accomplish work
Multitasks and manages time effectively
Acquiring new skills, learning quickly, can effectively cope with change and shift gears comfortably
Ability to work independently, supports other staff members by contributing, cooperating, sharing knowledge and working collaboratively with others and as part of a team
High School graduate or equivalent
Ability to use personal computers and effectively navigate common software programs
1-3 years medical billing preferred
Cannot have physical limitations that would prevent long periods of sitting
Must be able to lift 10 pounds in weight

Responsibilities

Review and process billing claims in a timely manner
Ensure accuracy of claims submitted to insurance companies and other payers
Resolve discrepancies and issues related to billing claims and insurance recoupment letters, and resolve accounts receivables to recover unpaid account balances
Communicate with healthcare providers, insurance companies and patients regarding bill inquiries
Maintain up-to-date knowledge of billing regulations and compliance requirements
Prepare and submit reconsiderations and appeals for denied claims
Collaborate and communicate effectively with other departments to improve processes
Reviews billings to patients after insurance carriers have paid or denied claims to ensure prompt account balances
Maintain detailed records of communications regarding financial status of patient accounts and collection efforts
Sorts, files and scans all correspondence
Maintains strict confidence of all patient accounts and complies with all company policies and HIPPA regulations
Report on up-to-date encounter/claim status during all Revenue Cycle meetings
All unpaid claims should have a follow-up call to the patient’s insurance company within 35-45 days of the date of service, and the first of each month thereafter
Respond to all incoming emails within two business days
Cross train with Clinic Biller handling like Health Plans
All encounters listed in Revenue Cycle’s At Risk Claim Queue and Past Due Queue must a have a status update documented on the timeline each month
Edit Failure, Late Charge Review, Pending Edit Claim and Technical Denial queues must be worked twice a week
Performs other jobs and/or duties as requested by Director