Medical Billing and Follow-Up Specialist – Full Time – Posted on 3.6.2018 – #072018
Internal and External candidates may apply at www.thayercountyhealth.com – click on Careers
POSITION SUMMARY: The Medical Billing & Follow-Up Specialist will be responsible for performing all aspects of insurance billing and follow-up functions within their assigned account inventory. They will ensure the timely and accurate submission of claims, follow-up on denied, underpaid, and aging claims, process refund requests, and resolve patient billing inquiries. Furthermore, they will ensure maximum reimbursement for services provided at TCHS by utilizing sound knowledge of insurance rules and regulations, best practice workflows, and the use of multiple software systems.
SHIFT: Full Time Non-Exempt Day Shift, 40 hours/week. SUPERVISION: Reports to the Revenue Cycle Director
1. High School Diploma is required.
2. Associates in Business or related field preferred.
3. Knowledge of medical terminology and/or insurance terminology is preferred.
4. One to three year experience in billing, follow-up, or registration within a hospital or clinic setting is preferred.
5. Requires excellent organizational, priority setting and problem solving skills.
6. Requires strong interpersonal skills and excellent verbal and written communication skills.
7. Requires great attention to detail, critical thinking skills, and the ability to work independently.
8. Requires proficient computer and keyboarding skills including Microsoft Office software
• Processes electronic and paper claims in a timely and accurate manner. Ensures edits to electronic claims meet and satisfy billing compliance guidelines for electronic submission.
• Verifies claims adjudication by utilizing appropriate resources and applications.
• Resolves clearinghouse and DDE claim errors and payer rejections on a daily basis.
• Performs immediate follow up on denials and partial payments by utilizing payer websites, phone calls to the payers, and/or internal inquiry.
• Preforms follow-up on aging unpaid claims utilizing payer websites and phone calls.
• Reviews remaining balances on accounts after insurance has paid to ensure the account was processed appropriately and performs the next appropriate action.
• Performs rebills of corrected claims, reconsiderations, and appeals as required.
• Resolves overpaid accounts by performing payment review to determine if posting corrections are required or/and a refund is due to the insurance company.
• Processes incoming correspondence from insurance companies, and performs proper action utilizing internal and external resources.
• Resolve issues holding up timely claim payment, including requests for medical records, coordination of benefit issues, and request for more information, by coordinating with the responsible department.
• Submits detailed adjustment requests to management by reviewing payer guidelines to determine claim viability.
• Accurately and thoroughly documents all actions performed on an account in the appropriate area of the EHR system.
• Initiates telephone or letter contact to patients to obtain additional information as needed.
• Manages and maintains assigned account inventory, completes required reports, and resolves high priority and aged inventory in a timely manner.
• Communicates issues to management, including payer, system, or escalated account issues. Identifies denial trends and provide suggestions for resolution.
• Resolves phone or written inquiries from patients and insurance companies regarding billing, charges, and account status.
• Maintains proficient knowledge of EHR, clearinghouse, and payer systems, as well as any other systems, required for performing required job duties.
• Assumes responsibility for personal and professional growth through participation in department meetings, in-service programs, continuing education programs, and fulfills yearly requirements as stated by policy. Participates in achieving organizational goals.
• Assists in orientation of new staff.
• Maintains a professional attitude with patients, visitors, physicians, office staff and hospital personnel. Assures confidentiality of patient and hospital information, maintaining compliance with policies and procedures.
• Any other duties as assigned by Revenue Cycle Director.