Sr. Billing Analyst

Hutchinson Regional Medical Center, Inc.•Hutchinson, KS

About The Position

Performs analysis related to customer billing, collections, and accounts receivable. Essential Responsibilities: Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position. Process medical insurance claims of various types for assigned payers, including follow up to final reimbursement Must have a working knowledge of payer contracts, member co-pays/deductibles/co-insurance and eligibility requirements for verifying accurate processing of remittance advices Responds to denials from payers such as invalid diagnosis and procedure codes and contractual arrangements, to ensure required information is transmitted to process payments Informs Management of any problems or changes in payer requirements and exercises independent judgment to analyze and report repetitive denials so that corrective action can be taken Resolves account discrepancies, to include but not limited to, credit balances, patient payment transfers, merge/audit requests, corrected claims, insurance over/under payments, and prompt pay discounts Contacts insurance payers for resolution of patients’ accounts Documents in the Patient Accounting system any action taken on the patient account Ensure completion or receipt of all documents needed for billing. Request and follow-up on documentation from physicians. Accurately enter documentation into computer system, prepare reports. Generate billing statements, ensure claims submitted are accurate, file secondary and/or tertiary insurance for co-payments and/or deductibles. Prepare and submit, on a daily basis, manual and/or electronic claim submission. Collect all money in a timely manner, work to resolve payment issues. Respond to customer inquiries. Act in accordance with the established mission, vision, and values. Abide by the Health Insurance Portability and Accountability privacy and security regulations regarding all aspects of Protected Health Information (PHI). Maintain effective communication and professional working relationships with patients/clients and their representatives, team members, contractors, physicians, peers, outside agencies, and the public. General Responsibilities: Perform other duties as assigned. People Management Responsibilities: Does this position have people management responsibilities?: Yes x No “Yes” indicates that this position entails overseeing and guiding team members, encompassing employment decisions and/or suggestions, as well as conducting formal performance assessments. "No" indicates that this position does not involve managing team members.

Requirements

High school diploma or GED
Recent Medicare insurance billing experience, including insurance follow-up on DDE/C-SNAP
Working knowledge and understanding of where to locate/how to read Medicare policies
Extensive knowledge of the Medicare website and the Learning Network
Working knowledge of Medical Necessity, LCD/NCD
Must display a high degree of independent judgment and professional skepticism to enhance the work performed in order to achieve success in the Medicare
3-5 years' experience in facility billing
Excellent writing and computer skills (Microsoft Office Word, PowerPoint and Excel) and database management skills.
Successful practices in customer service and problem resolution
Medicare specific knowledge regarding rules and regulations, including but not limited to the 72hr rule
Knowledge of insurance verbiage, claims processing and explanation of benefits
Excellent phone and customer relation skills.
Demonstrated ability to communicate effectively.
Basic computer knowledge and 10-key skills.

Responsibilities

Process medical insurance claims of various types for assigned payers, including follow up to final reimbursement
Must have a working knowledge of payer contracts, member co-pays/deductibles/co-insurance and eligibility requirements for verifying accurate processing of remittance advices
Responds to denials from payers such as invalid diagnosis and procedure codes and contractual arrangements, to ensure required information is transmitted to process payments
Informs Management of any problems or changes in payer requirements and exercises independent judgment to analyze and report repetitive denials so that corrective action can be taken
Resolves account discrepancies, to include but not limited to, credit balances, patient payment transfers, merge/audit requests, corrected claims, insurance over/under payments, and prompt pay discounts
Contacts insurance payers for resolution of patients’ accounts
Documents in the Patient Accounting system any action taken on the patient account
Ensure completion or receipt of all documents needed for billing. Request and follow-up on documentation from physicians.
Accurately enter documentation into computer system, prepare reports.
Generate billing statements, ensure claims submitted are accurate, file secondary and/or tertiary insurance for co-payments and/or deductibles.
Prepare and submit, on a daily basis, manual and/or electronic claim submission.
Collect all money in a timely manner, work to resolve payment issues.
Respond to customer inquiries.
Act in accordance with the established mission, vision, and values.
Abide by the Health Insurance Portability and Accountability privacy and security regulations regarding all aspects of Protected Health Information (PHI).
Maintain effective communication and professional working relationships with patients/clients and their representatives, team members, contractors, physicians, peers, outside agencies, and the public.
Perform other duties as assigned.