Summary:

The Specialist, Billing is responsible for managing the daily billing and ensuring timely accurate clean claims, claim reviews and resolves billing daily claim edits and ensuring compliance with Insurance billing policies and regulations.

Duties and Responsibilities:

Extensive understanding of billing guidelines for UB/1500 claims and a deep understanding of each claim field requirement. Maintain a list of split billing requirements by payer and add to the team crosswalk and keep abreast of any payer changes. The billing specialist should be well versed in Payer portal appeal uploads and assist with providing the internal team feedback when necessary. Import claims from host system into claims processing system when required. Review claims that are pended for edits and resolve. Prepare and submit accurate claims for patient services, ensuring compliance with third party payer guidelines and regulations. Review patient accounts and reconcile payments with secondary payers and review remittance advice, ensuring all payments are posted correctly and outstanding balances are addressed before filing the secondary payer. Ensure all billing and collection practices are compliant with CMS regulations, HIPAA, and company policies. Maintain accurate records of all claims and ensure proper documentation in the patient account system. Meet daily productivity and quality standards as assigned. Work with internal departments, such as patient financial services, finance, and billing, to address any issues or disputes affecting patient accounts. Assist management in maintaining or reducing account receivable (AR) days to meet industry standards and improve organizational cash flows.

Knowledge, Skills, and Abilities:

Proven experience in third party insurance billing, collections, or patient accounts, preferably in a healthcare setting. In-depth knowledge of billing codes, guidelines, and regulations. Familiarity with electronic health record (EHR) systems, billing software, and remittance advice processing. Strong communication skills, with the ability to explain Medicare billing details and resolve patient concerns effectively. Ability to handle sensitive information and maintain confidentiality in accordance with HIPAA regulations. Detail-oriented with strong organizational skills and the ability to manage multiple accounts simultaneously. Problem-solving abilities, particularly regarding billing discrepancies and denied claims.

Work Experience, Education and Certificates:

Experience utilizing Payer portals, client systems and clearing house requirements 3-5 years of experience as a primary biller in hospital Business Office. Medical Terminology, ICD-10, CPT and DRG knowledge a preferred, knowledge of third-party Insurance payer guidelines High school diploma or equivalent; additional training in medical billing is a plus.

Working Conditions and Physical Requirements:

Work from home and remote location with a stable internet connection, a quiet and dedicated workspace free of distractions, and access to necessary office equipment. The ability to have daily communication with team members, management, and clients through email, phone calls, video meetings and other collaborative tools. Primarily requires sitting at a desk for extended period. Proper lighting and ergonomics shole be maintained to reduce eye strain.

Travel Requirements:

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