Insurance Billing Specialist

Shenandoah Medical Center • Shenandoah, IA

2d

About The Position

The Insurance Billing Specialist is responsible for reviewing and submitting claims for payment, processing Medicare DDE, completing timely follow-up on accounts, and performing regular reviews of aging reports. This role involves working with payers on denials, ensuring accurate account balances, and reporting issues to a supervisor. The specialist will also handle other assigned duties, including submitting reconsiderations and appeals, and completing required training and exams.

Requirements

• Review and submit clean claim for payment
• Reviews and corrects all claim edits in the clearinghouse.
• Reviews and corrects all edits within the EMR software.
• Ensure proper secondary billing.
• Review and submit Paper claims with required attachments if appropriate.
• Verifies all unknown information with the appropriate department.
• Process Medicare DDE.
• Review and correct all Medicare claim edits for submission to WPS.
• Review and correct all Return to Provider claims.
• Completes Timely Follow-Up.
• Reviews account balances to ensure accuracy.
• Achieves department weekly goal for follow-up.
• Works with payers on denials with processes including, but not limited to, phone call verifications, medical records submission, reconsideration and appeals.
• Ensures the proper and timely submission of patient responsibility to statement vendor.
• Completes Regular Review of Aging.
• Reviews aging reports on a regular basis.
• Completes frequent follow up on aged accounts.
• Reports issues to direct supervisor.
• Performs other duties as assigned.
• Submission of reconsideration and appeals for payer denials as required.
• Completes and passed all training and exams.

Responsibilities

• Review and submit clean claim for payment
• Reviews and corrects all claim edits in the clearinghouse.
• Reviews and corrects all edits within the EMR software.
• Ensure proper secondary billing.
• Review and submit Paper claims with required attachments if appropriate.
• Verifies all unknown information with the appropriate department.
• Process Medicare DDE.
• Review and correct all Medicare claim edits for submission to WPS.
• Review and correct all Return to Provider claims.
• Completes Timely Follow-Up.
• Reviews account balances to ensure accuracy.
• Achieves department weekly goal for follow-up.
• Works with payers on denials with processes including, but not limited to, phone call verifications, medical records submission, reconsideration and appeals.
• Ensures the proper and timely submission of patient responsibility to statement vendor.
• Completes Regular Review of Aging.
• Reviews aging reports on a regular basis.
• Completes frequent follow up on aged accounts.
• Reports issues to direct supervisor.
• Performs other duties as assigned.
• Submission of reconsideration and appeals for payer denials as required.
• Completes and passed all training and exams.

What This Job Offers

• Career Level: Mid Level
• Education Level: No Education Listed