Insurance Billing Specialist

Shenandoah Medical Center • Shenandoah, IA

1d

About The Position

The Insurance Billing Specialist is responsible for reviewing and submitting clean claims for payment, processing Medicare DDE, completing timely follow-up on accounts, and regularly reviewing aging reports. This role also involves performing other duties as assigned, including submitting reconsiderations and appeals for payer denials and completing all required training and exams.

Requirements

• Experience with claim edits in clearinghouse and EMR software
• Experience with secondary billing
• Experience with paper claims submission
• Experience with Medicare DDE
• Experience with WPS
• Experience with Return to Provider claims
• Ability to review account balances for accuracy
• Ability to meet department weekly goals for follow-up
• Experience working with payers on denials, including phone call verifications, medical records submission, reconsideration and appeals
• Experience with timely submission of patient responsibility to statement vendor
• Experience reviewing aging reports
• Experience with frequent follow-up on aged accounts
• Ability to report issues to direct supervisor
• Ability to submit reconsideration and appeals for payer denials
• Ability to complete and pass 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