INSURANCE BILLING SPECIALIST en Memorial Regional Health

To submit health insurance claims to payers and collect on accounts.

ESSENTIAL FUNCTIONS AND BASIC DUTIES:

Supervisory-Specific Performance Expectations, Duties, and Responsibilities:

o   N/A

Position-Specific Performance Expectations, Duties, and Responsibilities:

o   Process and submit health insurance claims to various insurance companies in a timely and accurate manner.

o   Ensure claims are coded correctly in compliance with the latest medical coding and billing guidelines (CPT, ICD-10, HCPCS).  Collaborate with the coding and clinical departments to resolve edits and denials.

o   Maintain a working knowledge of Medicare and Medicaid as well as commercial payer guidelines, and stay abreast of new policy changes.

o   Verify patient eligibility and coverage details before claim submission, and reconcile coverage denials when necessary.

o   Resolve claim edits both in the electronic medical record and in the clearinghouse to prevent denials.

o   Follow up with insurance companies regarding denied or underpaid claims, and submit appeals when appropriate.

o   Review insurance and patient credit balances and resolve them timely.

o   Educate patients on their billing inquiries, providing clear and accurate explanations regarding their insurance coverage and payment responsibilities.

o   Document all actions taken with an account in the electronic medical record (EMR).

o   Performs other duties as assigned.

Organization-Specific Performance Expectations, Duties, and Responsibilities:

o   Demonstrates 100% commitment to performance in accordance with the CHOICE values of MRH and representing the organization in a positive and professional manner.

o   Establishes and maintains effective verbal and written communication and good working relationships with all patients, staff, and vendors.

o   Adheres to MRH attire/dress code per policies and procedures.

o   Utilizes initiative; strives to maintain a steady level of productivity; self-motivated; and manages activity and time.

o   Completes annual education, training, in-service, and licensure/certification requirements; and attends departmental and organizational staff meetings or reads meeting minutes.

o   Maintains patient confidentiality at all times.

o   Reports to work on time as scheduled; completes work within designated timeframes.

o   Actively participates in departmental and organizational performance improvement and continuous quality improvement activities.

o   Strives to uphold regulatory requirements to ensure continual compliance with departmental, hospital, state, and federal regulations and policies.

o   Follows policies and procedures for infection control, safety, and risk management to ensure a safe environment for patients, the public, and staff.

QUALIFICATIONS:

Minimum Requirements:

o   Must be at least 16 years of age (21 for driving positions with a valid driver’s license).

o   Must be able to legally work in the United States.

o   Must be able to pass a background check.

o   Must be able to pass a drug screen and breath alcohol test (if applicable).

o   Must complete employee health meeting.

Required Education/Licensure/Certification:

o   Medical billing or coding certification highly desired (CPC, CPB, RHIT, CCS, etc.).

o   High School Diploma or equivalent, preferred.

Experience:                                                                         

o   Two (2) years prior experience in medical billing, accounts receivable, or related field required (can substitute with a medical billing or coding certification (CPC, CPB, RHIT, CCS, etc.).

o   Knowledge of UB-04 and CMS-1500 claim forms, preferred.

o   Epic or similar EMR experience, preferred.

o   Prior authorization process experience, preferred.

o   Typing speed of a minimum of 30 WPM, preferred.

o   Proficiency in Excel, preferred.

• Position Classification:  Non-Exempt

  Compensation Range: $25.04 to $37.56

  Benefits:  Medical, Dental, Life, Retirement, Paid Time Off

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