Insurance Billing Specialist (hybrid), full time, days

Holland Hospital • Holland, MI

5d • Hybrid

About The Position

Holland Hospital is seeking an Insurance Billing Specialist to provide exemplary customer service. This role involves daily use of the electronic billing system (Cerner & nThrive) to submit insurance claims to third-party payers. The specialist will review and correct daily claim edits from the hospital billing system to ensure electronic submission, and assess and analyze claim edits within 24-48 hours. A thorough understanding of federal and state regulations, including Medicare, Medicaid, and fiscal intermediary requirements, is necessary for compliant claims submission. The position also involves preparing and submitting manual insurance claims, resubmitting corrected claims, verifying claim receipt, and resolving claim transmission issues. Additionally, the specialist will perform timely follow-up on outstanding debit and credit balances, review and analyze these balances, and contribute to departmental success while maintaining compliance with patient and billing aspects. A baseline understanding of federal and state regulations, payer requirements, and explanation of benefits is crucial. Effective communication via email, telephone, and instant message with payers and internal departments is expected, along with strict adherence to HIPAA guidelines. Incoming patient and insurance correspondence must be reviewed, processed, and resolved within one business day, with timely responses to formal communications. All activities must be documented clearly and concisely in the billing system, including timely phone calls to insurance companies. The role requires staying current on healthcare regulations, attending training, and performing other related duties as assigned. Holland Hospital is an Equal Opportunity Employer.

Requirements

• High school diploma/GED or higher education
• Works daily electronic billing system (Cerner & nThrive)
• Thorough understanding of federal and state regulations as well as requirements specific to Medicare, Medicaid, and fiscal intermediaries
• Understands and maintains compliance with HIPAA guidelines when handling patient information
• Clear and concise messaging

Nice To Haves

• Contributes innovatively to the success of our department
• Maintains a base-line understanding of federal and state regulations, as well as specific payer requirements and explanation of benefits
• Builds relationships and fosters positive communication with applicable departments outside of PFS.

Responsibilities

• Works daily electronic billing system (Cerner & nThrive) and submits insurance claims to third-party payers.
• Reviews daily claim edits from the hospital billing system and makes necessary corrections to allow electronic submission.
• Assesses and analyzes claim edits daily within the billing system leading to a resolution within 24-48 hours.
• Maintains a thorough understanding of federal and state regulations as well as requirements specific to Medicare, Medicaid, and fiscal intermediaries in order to promote compliant claims submission practices for governmental claims.
• Communicates any edits that may need joint resolution with external departments.
• Prepares and submits manual insurance claims to third-party payers who do not accept electronic claims or who require special handling.
• Resubmission of claims that may need corrections.
• Verify that claims have been received by the appropriate payer.
• Investigate and resolve any issues in regards to claim transmission.
• Mail/Fax/Email paper claims to the appropriate payer the day they are generated.
• Performs effective, timely and efficient follow-up on all outstanding debit and credit balances within the expected time period.
• Review and analyze outstanding debit and credit balances to determine appropriate follow-up.
• Contributes innovatively to the success of our department and is compliant in all patient and billing aspects.
• Maintains a base-line understanding of federal and state regulations, as well as specific payer requirements and explanation of benefits to ensure compliance.
• Effectively handles communications, including email, telephone and instant message, from payers and departments within and outside of the department.
• Understands and maintains compliance with HIPAA guidelines when handling patient information.
• Reviews, processes, and resolves all incoming patient and insurance correspondence within one business day.
• Reviews and prepares responses to correspondence from patients and insurance carriers within a reasonable time frame.
• Responds to formal communication, both external and internal, within a reasonable time frame.
• Documents all activity within an encounter in the billing system.
• Responsible for making and documenting timely phone calls to insurance in regards to billing matters within the billing system.
• Provides updates to existing policies and procedures as needed and proposes new.
• Communicates with staff routinely and effectively using all forms of communication.
• Builds relationships and fosters positive communication with applicable departments outside of PFS.
• Documents all activity - each time an account is touched - in the notes section of the AR Host I.S. System, at the account level, appropriately, timely, compliantly and thoroughly.
• Stays current on healthcare regulations.
• Attends training sessions, internal and external.
• Performs other related duties as assigned.

Benefits

• Holland Hospital is an Equal Opportunity Employer
• nurture the continued health and wellness of our most valuable asset: our employees
• collaborative, can-do culture
• family-like feel

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED