Position Summary:
The Billing Specialist processes, appeals and follows up on claims to all payers, including government, commercial, worker’s compensation and liability payers. The Specialist must gain a familiarity with many payer policies and procedures, including rules for claims appeals, rules regarding the use of ABNs, payer website navigation, coordination of benefits, and filing limits to obtain payment for services rendered from the appropriate party The Billing Specialist will also answer all incoming calls from patients for a host of reasons including but not limited to; statement disputes, insurance questions, making payments, financial assistance, and patient quality issues. In addition, the Billing Specialist must also apply critical thinking skills and judgment to coordinate resolution of patient questions with coding, providers, PSRs and clinical staff on a regular basis.
Key Outcomes:
- Prioritize workload to align with department metrics and goals
- Follow our current AR aging workflow in order to minimize loss of revenue for the delivery system
- Answer incoming patient calls and address patient issues and concerns in a timely manner
- Research and resolve insurance overpayments
- Research and process patient credit balances
- Work with individual payers to resolve issues affecting claims processing
- Process and respond when needed to patient and payer correspondence
- Act as a resource to the sites which are assigned, including occasionally traveling to the site to help with PSR education and training
- Assist patients with issues related to accounts in collections and accounts from legacy systems
- Research & resolve balances that are unable to be applied against a patient’s account by athena
- Appeal denials and send corrected claims to payers
- Correctly classify payer Incentive Payments according to appropriate MPHC contracts
- Maintain positive relationships through communication and commitment to the team and their work
- Learn new workflows and demonstrate flexibility when needed to help other teams or work on special projects identified by management
- Work closely with the coding team to maximize revenue and decrease the number of rejected claims
Education/Experience:
- High School Diploma or GED
- 2+ years clerical or related experience
- Data Entry experience
- Primary care claims experience preferred
- Knowledge of medical terminology, ICD-9 & ICD-10, CPT and HCPCS coding preferred
- Must be proficient in use of computers, terminals and keyboards
- Experience with MS Office products preferred
Skills/Knowledge/competencies:
- Demonstrates an understanding of and alignment with Martin’s Point Values.
- Ability to maintain confidentiality of healthcare data (HIPAA Compliance)
- Capacity to be cross trained to new payer types as business indicates
- Demonstrates significant change agility
- Ability to demonstrate MPHC Core Competencies
- Team player
- Excellent organizational skills and attention to detail