Billing Specialist (Remote)

Billing Specialist Representative is responsible for following up directly with commercial and governmental payers to resolve billing issues and secure appropriate reimbursement in a timely manner. This individual identifies and analyzes denials and payment variances and enacts corrective measures such as needed to effectively communicate and resolve payer errors. MISSION, VALUES and SERVICE GOALS

• MISSION: We deliver outstanding care, inspire health, and connect with heart.
• VALUES: Trust. Respect. Integrity. Compassion.
• SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Audit Process

• Reviews patient accounts data including demographic patient/guarantor information, insurance information, and appropriateness of charges.
• Communicates identified problems to appropriate management and participates in appropriate corrective action.
• Ensures all appropriate documentation, including but not limited to, updated addresses, account notes, etc. has been entered into the Patient Accounting system for future reference.

Billing/Follow up

• Enters correct patient account data to impact the production of an accurate and appropriate UB-04 or CMS1500 claim form.
• Ensures proper conformance with established government and third-party processing standards by working all edit errors to ensure clean claims are submitted to payers.
• Corrects any errors in charging and/or insurance data to facilitate submission of a clean claim.
• Submits and/or mails accurate and complete UB04 or CMS1500 claim forms to payors in a timely manner.
• Demonstrates ability to submit primary governmental and commercial claims electronically daily. Ensure that status of claims and the billing secondary claims are submitted in an accurate manner.
• Completes prompt follow-up of outstanding receivables and takes appropriate action to ensure timely reimbursement including filing disputes and appeals.
• Ensures denied claims have been corrected and rebilled in a timely manner.
• Keeps abreast of changes in policies, procedures, regulations and requirements of the governmental payor.
• Request, prepares and submits necessary documents required for payment including but not limited to prior authorizations, consent forms and letter of non-coverage.
• Analyze denied and underpaid claims to determine reasons for discrepancies
• Communicates directly with payers to follow up on outstanding claims, resolve payment variances, and achieve timely reimbursement
• Provides payers with specific reasons for suspected underpayments and analyzes denial reasons given by payers.
• Works with management to identify, trend, and address root causes of denials; helps pinpoint strategies for reducing A/R.
• Maintains a thorough understanding of federal and state regulations, as well as specific payer requirements and explanations of benefits, to identify and report billing compliance issues and payer discrepancies.
• Effectively handles all communications, including telephone, portal messages and email from payers and departments within the business office.
• Identifies high-risk accounts and prioritizes follow-up efforts.
• Participates in continuous quality improvement efforts on an ongoing basis, establishing goals with leadership and tracking progress.
• Resolves the encounter balance to zero, which includes credit balance by correcting adjustments and issuing refunds to the appropriate payer.
• Demonstrates initiative and resourcefulness by making recommendations and communicating trends and issues to management.
• Understands and maintains compliance with HIPAA guidelines when handling patient information.

Communications

• Demonstrates good interpersonal skills by communicating with customers, patients, physicians, co-workers and other departments in a friendly, caring, sincere and cooperative manner.
• Communicates with internal and external departments or agencies to provide or obtain information to resolve outstanding account receivables.

Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by:

• Completing other job-related assignments and special projects as directed.

Compliance & Communication

• Maintain compliance with HIPAA and all applicable billing regulations.
• Respond to payer communications via phone, portal, and email in a professional and timely manner.
• Collaborate across teams to ensure coordinated resolution of account issues.
• Communicate effectively with patients, coworkers, and external partners, always maintaining professionalism and respect.

ORGANIZATIONAL RESPONSIBILITIES Associate complies with the following organizational requirements:

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established timeframes.
• Completes annual employee health requirements within established timeframes.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

Commitment to Beacon's six-point Operating System, referred to as The Beacon Way:

• Leverage innovation everywhere.
• Cultivate human talent.
• Embrace performance improvement.
• Build greatness through accountability.
• Use information to improve and advance.
• Communicate clearly and continuously.

Education and Experience

• Associate or bachelor’s degree preferred in a healthcare related field.
• Two to three years of relevant experience insurance billing and follow up preferred (collections).
• Candidates with hospital background preffered.

Knowledge & Skills

• Demonstrated technical knowledge of the UB04 and CMS1500 claim form and its use and application for government billings.
• Demonstrated technical knowledge of government agency policies, procedures, regulations and requirements.
• Basic computer and word-processing skills.
• Proficiency with Microsoft 365 including Word, Excel, Outlook.
• Possess critical thinking skills to quickly problem solve issues.
• Knowledge of claims review and analysis.
• Effective communication, organizational, and problem-solving skills.
• Ability to manage multiple tasks and projects simultaneously.
• Adapts positively to changes in the working setting with ease.
• Strong interpersonal and customer service skills.

Working Conditions

• Prolonged exposure to a computer.
• Extended periods of time sitting.

Physical Demands

• Occasional lifting of storage boxes weighing up to 50 pounds when filled with completed forms.

Location: Beacon Health System · Corporate Patient Accounting Schedule: Full-time, Day, M thru F 8:00 - 4:30 Apply tot his job Apply To this Job