Two years of medical billing experience and one year experience with electronic billing.
Epic experience desired.
Knowledge, Skills and Abilities
Thorough knowledge and understanding of medical billing, insurance and private pay.
Knowledge of all medical billing requirements for Medicare, Blue Cross, Medical Assistance, Commercial insurance, and HMO carriers
Strong collection skills, including claims follow-up, revenue cycle practices
Strong computer skills, including EMR knowledge and Microsoft Office. Excel preferred.
Strong interpersonal skills
Excellent verbal and written communication skills for interacting with patients, families, insurance companies and healthcare providers.
Strong ability to investigate issues, find solutions, and work under pressure to resolve billing issues.
Efficient in managing multiple tasks, prioritizing, and ensuring deadlines are met.
Ability to handle multiple claims and billing tasks simultaneously while maintaining quality and accuracy
Licensures, Certifications
N/A
Principal Duties and Responsibilities
Manages assigned Epic work queues daily to ensure accurate billing and expedient claims follow-up.
Claims Billing Processes
Ensures timely submission of all claims within assigned financial classes.
Ensures timely follow up of all claims within assigned financial classes
Claim Resolution Processes
Investigates claim denials or rejections
Completes functions in order to resolve claims
Uses all available tools such as but not limited to: Online access, calling the insurance companies; working with provider representatives.
Identifies appeals
Identifies secondary billing for accounts with secondary liability; follows-up on any unpaid balances. Brings these claims to resolution.
Identifies patient self-pay balances and bills timely to patient/family. Follow-ups as necessary including calling for follow up.
Process any late charge claims, claims resubmission and/or claims corrections to payors.
Enters and posts payment to patient accounts based on remittance advice review.
Reconcile accounts and ensure any underpayments or overpayments are corrected
Responds to patient and third-party payor inquiries regarding patient accounts via e-mail, telephone, mail, and in person.
Audits primary patient bills for submission to third party payers via electronic billing or manual claim submission.
Maintain detailed and accurate billing records for auditing purposes and compliance with industry regulations
Maintain thorough records of all communication with insurance providers and patients regarding claims.
Participate in meetings with Provider Reps to resolve denial discrepancies
Prepare and submit appeals for denied claims. Understanding of additional documentation necessary to submit an appeal
Obtain an in-depth understanding of hospice billing regulations. Ensure compliance with federal, state and local billing laws, including HIPAA regulations.
Prepare reports to managers recommending accounts for bad debt adjustments. Maintaining lost revenue at a level of less than 1% of net healthcare revenue
Recommends accounts for transfer to bad debt.
Physical Requirements
Ability to sit, concentrate and pay close attention to detail
Working Conditions
Normal office environment with little exposure to excessive noise, dust, temperatures and the like
Conditions of Employment
All roles must demonstrate GBMC Values
GBMC Values
Value Description
Respect
I will treat everyone with courtesy. I will foster a healing environment.
Treats others with fairness, kindness, and respect for personal dignity and privacy
Listens and responds appropriately to others' needs, feelings, and capabilities
Excellence
I will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others.
Meets and/or exceeds customer expectations
Actively pursues learning and self-development
Pays attention to detail; follows through
Accountability
I will be professional in the way I act, look and speak. I will take ownership to solve problems.
Sets a positive, professional example for others
Takes ownership of problems and does what is needed to solve them
Appropriately plans and utilizes required resources for various job duties
Reports to work regularly and on time
Teamwork
I will be engaged and collaborative. I will keep people informed.
Works cooperatively and collaboratively with others for the success of the team
Addresses and resolves conflict in a positive way
Seeks out the ideas of others to reach the best solutions
Acknowledges and celebrates the contribution of others
Ethical Behav
Benefits
Health insuranceVision insurance
Additional Information
Under direct supervision, performs all billing and collection functions on account balances within assigned financial classes. Ensures timely submission of all claims and timely follow up. Posts payments in EPIC. Perform eligibility, verification and authorization requests, as needed. Education
High School diploma or equivalent required. Associate's degree preferred.
Gbmc · Gilchrist Hunt Valley