Senior Revenue Cycle Billing Specialist - FT - Day - Hospital Billing Lawrenceville NJ

Capital Health (US)•Pike, NY

1d•Onsite

About The Position

Acts as a front-line resource for staff inquiries, coaching, and training as it pertains to the healthcare claim submission life cycle. Has a strong understanding of all essential functions within billing department and can articulate and disseminate information to staff timely and effectively. Supports billing management and work focused projects, as well as provide feedback. Responsible for all aspects of claim submission for services rendered at Capital Health through the Revenue Cycle life cycle to all payers, including but not limited to pre and post claim review, claim (277) rejections, denial review, and claim resubmission. Provides, elicits, and gathers information to facilitate, expedite, and obtain professional payments from third party carriers. Performs collection and follow-up activity with insurance companies. Completes necessary billing projects as assigned. Meets internal and external customer expectations.

Requirements

Three years' previous healthcare billing experience in a hospital, professional, or medical office setting.
Intermediate knowledge of Microsoft office products, specifically word and excel.
Proficient experience using Electronic Medical Record (EMR) software.
Cerner, Athena, Epic preferred.

Responsibilities

Assists with training and onboarding of all new hires.
Acts as a resource for problem solving and education for Hospital Billing Revenue Specialists.
Communicates effectively to Leadership and identifies opportunities for improvement.
Supports department performance improvement initiatives.
Assigns worklist to billing staff and helps maintain and drive productivity standards.
Responsible for all claims submitted to payer.
Analyzes claims for errors and makes corrections prior to submission.
Analyzes claims for errors during all stages of submission for accuracy of billing.
Maintains current knowledge of payer requirements.
Demonstrates a comprehensive understanding of team functions and specialized terminology of third-party payers.
Works closely with appropriate staff/departments to make corrections and ensures accuracy for the days’ work (ex: coding and patient access: CCI edits, Medical Unlikely edits, demographic information, date of birth, etc).
Resolves all Return to Provider (RTP) claims in error in the Medicare Fiscal Intermediary Shared System (FISS) on a daily basis (hospital only).
Resolves the New Jersey Discharge Data Collection System (NJDDCS) MIDS errors on a routine basis as defined by management (hospital only).
Verifies covered days (hospital) and services to be rendered (hospital/professional) prior to submitting claims in a timely manner.
Corrects errors from the daily claim (277) rejections or escalates to the appropriate department for resolution.
Reviews hospital billing reports for corrections needed in order to have the accounts final bill – these include but are not limited to: Late Charge report, 72-hour report, etc. to ensure claims are billed timely and accurately (hospital only).
Evaluates, reviews, and analyzes patient accounts to determine if third party payments have been received, recorded, and are appropriate based on contractual expectations.
Review patient’s account in totality, including demographic information, service rendered, insurances documentation, etc to gain full understanding of the patient’s A/R.
Performs appropriate follow-up which could include calls to payers, claim review on payer portal, manual adjustment to account balance and financial class changes, where relevant.
Answers calls and other inquiries from payer representative timely regarding accounts and completes proper documentation of all activity on each account.
Identifies and communicates payment variances, error trends, and account issues for resolution to management.
Identifies denial trends and reports them to management to allow for more efficient billing and timely resolution.
Reviews credit balances for adjustments, refund and/or claim adjustment submission as assigned.
Researches and retrieves appropriate documentation (e.g. authorizations, medical records) for appealing denials.
Works correspondence as assigned and escalated by correspondence team.
Communicates denials and other issues with the appropriate Revenue Cycle department and/or physician representative to address root causes.
Documents clear and concise notes in the billing system.
Operates other relevant computer software efficiently to complete required billing and follow-up tasks.
Enters charges into Billing System from various reports, where relevant.
Performs assigned worklists and other duties quickly and accurately showing attention to details and is sufficiently organized to produce quality work.
Maintains assigned productivity standards and escalates obstacles in accomplishing expectations in a timely manner.
Prioritizes and updates files and other required documentation in accordance with established policies, guidelines, and procedures.
Demonstrates willingness to adapt to changing departmental demands as new billing duties are required.
Completes special assignments and projects with minimal supervision and consistently meets targets.
Performs other duties as assigned and adapts to changing departmental demands.