Insurance Biller

St. Elizabeth Healthcare

About The Position

At St. Elizabeth Healthcare, every role supports our mission to provide comprehensive and compassionate care to the communities we serve. For more than 160 years, St. Elizabeth Healthcare has been a trusted provider of quality care across Kentucky, Indiana, and Ohio. We’re guided by our mission to improve the health of the communities we serve and by our values of excellence, integrity, compassion, and teamwork. Our associates are the heart of everything we do. This position is responsible for timely and accurate billing of assigned accounts to a variety of payors using the computerized patient accounting systems. Responsibilities also include staying current with UB-04 and HCFA-1500 billing requirements, HIPAA Regulations, Payor Regulations, and Payor Contractual Agreements to ensure proper billing and compliance. This position is responsible for communication to supervisor/manager as to identify issues associated with charges, billing, etc. so billing systems are programmed accurately for billing. Demonstrate respect, dignity, kindness, and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background.

Requirements

High School diploma or GED
PC Skills, including Word and Excel.
Detail Oriented
Customer Service Skills
Excellent Communication Skills
Billing or Follow Up experience
One year’s experience in billing or follow-up activities
Experience in customer service, billing or related field.

Responsibilities

Review bills and related information for accuracy and reasonableness of charges
Audit claims for overlap (charges, dates, coding, condition codes, modifiers, discharge status) and resolves issues with medical records and revenue department heads. (as applicable)
Work Specific Reports (as applicable)
Submit bills to payers electronically if possible, otherwise paper
Proficient in Commercial/Medicare/Medicaid Government regulations and reimbursement policies
Proficient in third party contractual agreements and regulations to apply requirements for accurate billing and to make recommendations for system changes as needed
Stay current with third party contractual arrangements and regulations (Medicare, Medicaid, Champus, managed care, etc.) to apply requirements for accurate billing and to make recommendations for system changes as needed.
Compute required adjustments to bills, balances to support, and inputs debits/credits to billing system to appropriate codes to ensure accurate billing.
Follow up on unbilled claims pending Medical Records coding, claim forms, etc. in order to bill on a timely basis.
Take appropriate action to resolve claims.
Execute any, and all, steps to resolve unpaid, including but not limited to; rebill of claim
Perform due diligence on all collection efforts
Assist other associates when necessary, as determined by manager, work with staff to identify and resolve issues and develop standard
Elevate serious barriers to claim resolution to appropriate management
Demonstrate adequate, appropriate, and professional levels of communication with insurance company representatives, team members, supervisors, and managers
Record approved detailed note in the billing system
Ensure expected reimbursement is secured with knowledge of billing system Expected Reimbursement data or payor contract
Meets productivity and quality standards on a weekly basis
Understand and adhere to the concepts of stratification
Demonstrate ability to work with high volume edits
Ensure timely turnaround of internal requests (EOB’s, medical records)
Seek opportunity for training and informs supervisor of all training needs
Complete special projects & tasks by the established time frame which can include organizing workload and/or associates for successful account resolution: proactively notify supervisor of any barriers that prohibit billing and/or payment of claims
Assume duties of supervisor or lead as needed.
Assist co-worker in problem solving, with reports, meetings, etc.
Complete other billing tasks and duties as assigned by manager
Execute training of contract staff (internal and external)
Act as a preceptor for new employees and as a resource within the department
Trends weekly productivity, Billing CFB, Open AR Edit WQs (Securing required data necessary for billing.)
Attends weekly billing staff meetings
Identifies payer & billing issues
Participates in a positive & constructive manner
Respond to internal and external customer calls or concerns.
Attends Seminars and workshops as assigned by manager, to obtain billing and/or follow up information related to specific payers.
Perform other duties as assigned.