CRMG Billing Specialist

Cheyenne Regional Medical Center•Cheyenne, WY

30d

About The Position

The CRMG Billing Specialist is responsible for timely, accurate patient account billing and payer reimbursement. The role ensures coordination of benefits is accurate and that payer reimbursement aligns with organizational payer contracts. It also provides customer service to patients, payers, and other parties.

Requirements

High school diploma or an equivalent certificate from an accredited program, or a higher degree.
At least six months 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 strong attention to detail.
Ability to type at least 40 words per minute.
Ability to handle cash.
Knowledge of medical terminology and coding.

Nice To Haves

Completion of a billing/coding program with certification.
Healthcare and/or insurance billing experience.
Home care billing experience.

Responsibilities

Pursue and participate in education about assigned payers to stay current on healthcare industry changes through payer websites, newsletters, webinars, and assigned payer meetings.
Review accounts daily in assigned Epic Work Queues and prioritize them by dollar amount and timely filing rules to achieve the best possible reimbursement.
Research accounts to submit claims to the appropriate payer based on coordination of benefits and coverage active when services were rendered.
Evaluate payer remittance advice and explanations of benefits on denials for accuracy according to individual payer contracts.
Maintain knowledge of Medicare, Medicaid, commercial insurance programs, Medicare HMOs, and state programs, including filing deadlines, billing requirements, and reimbursement methods.
Compose and submit appeals to third-party payers, escalating appeals to the highest level to resolve account denials and obtain proper reimbursement.
Respond in a timely manner to patient, payer, attorney, and third-party inquiries received by phone or correspondence; review available information and direct accounts appropriately.
Meet or exceed assigned performance metrics, focusing on reducing Accounts Receivable Days and denial rates.
Provide management with feedback on denial trends and claim edits to support process improvement and quality assurance in billing software.
Provide exemplary customer service and communicate courteously, accurately, honestly, and positively.