Billing Specialist

POSITION SUMMARY:

This position will be responsible for performing billing and follow-up functions, including the investigation of payment delays, resulting from no response, denied, rejected and/or pending claims with the objective of appropriately maximizing reimbursements and ensuring that claims are paid in a timely manner. This position requires strong decision-making ability around complex claims processing workflows and requires utilization of data coming from multiple resources.

BCH POLICY STATEMENT:

It is the obligation of each employee of Boone County Hospital (BCH) to abide by and promote BCH's mission, values, Code of Conduct, Standards of Behavior, policies, procedures, and related practices. This includes policies relating to Compliance, Infection Control and Safety.

HIPAA SECURITY COMPLIANCE:

Boone County Hospital is committed to following all federal guidelines related to privacy and security. All employees will be held to the highest standard of confidentiality and will be required to annually sign an employee confidentiality agreement that outlines the rules and expectation for every BCH employee. Failure to abide by these guidelines could lead to disciplinary action including termination.

Security Access: High Incumbent has access to restricted or confidential patient information and must comply with the terms of the BCH privacy & security policies as it applies to their job.

BEHAVIORAL REQUIREMENTS:

Boone County Hospital has developed standards for behavior expectations of all employees. Please refer to the Boone County Hospital Standards of Behavior.

ESSENTIAL FUNCTIONS:

• Resolve billing errors and edits to ensure all claims are filed in a timely manner
• Ensure all claims are accurately transmitted daily and all appropriate documentation is sent when required
• Verify eligibility and claims status on unpaid claims
• Review payment denials and discrepancies and take appropriate action to correct the accounts/claims.
• Respond to customer service inquiries
• Perform charge corrections when necessary to ensure services previously billed incorrectly are billed out correctly
• Submit replacement, cancel and appeal claims to third party payers
• Provide timely feedback to management of identified claims issues, repetitive errors, and payer trends to expedite claims adjudication
• Work accounts in assigned queues in accordance with departmental guidelines
• Contact patients for needed information so claims are processed /paid in a timely manner
• Work directly with third party payers and internal/external customers toward effective claims resolution
• Other duties as assigned by the Patient Financial Service Director

MINIMUM KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:

• Prefer one year of experience within a hospital or clinic environment, an insurance company, managed care organization or other financial service setting, performing medical claims processing and or financial counseling.
• High School Diploma or GED
• Interpersonal skills
• Written and verbal communication
• Basic computer skills
• Motivation, teamwork and professionalism
• Customer/Patient focused
• Planning and organizational skills

PHYSICAL ACTIVITY REQUIREMENTS:

EQUIPMENT/TOOLS:

Operate office equipment such as computers, printers, copy machine, calculator, facsimile, multi-line phone system, and scanners.

WORKING CONDITIONS:

Typical working conditions include sitting at a desk for extended periods, while working on a computer or talking on the phone.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.

Vision must be correctable to view computer screens and read printed information. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, and ability to adjust focus.

Hearing must be in the normal range for telephone contacts and other conversations.

The above is intended to describe the general content of and requirements for this job. It is not intended to be a complete statement of duties, responsibilities, or requirements.