Revenue Cycle Billing Specialist - FT - Day - Hospital Billing Lawrenceville NJ

Benefits

Additional Information

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region. Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates. The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time). Pay Range: $19.32 - $24.13 Scheduled Weekly Hours: 40 Position Overview Responsible for all aspects of claim submission for services rendered at Capital Health through the Revenue Cycle life cycle to all payers, including but not limited to pre and post claim review, claim (277) rejections, denial review, and claim resubmission. Provides, elicits, and gathers information to facilitate, expedite, and obtain professional payments from third party carriers. Performs collection and follow-up activity with insurance companies. Completes necessary billing projects as assigned. Meets internal and external customer expectations. MINIMUM REQUIREMENTS Education: High school diploma or equivalent. Experience: One year' previous healthcare billing experience in a hospital, professional, or medical office setting. Other Credentials: Knowledge and Skills: Special Training: Working knowledge of Microsoft office and excel. Experience using Electronic Medical Record (EMR) software. Cerner, Athena, Epic preferred. Mental, Behavioral and Emotional Abilities: Can work well independently and in team settings. Usual Work Day: 8 Hours Reporting Relationships Does this position formally supervise employees? No If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager. ESSENTIAL FUNCTIONS Responsible for all primary and secondary claims submitted to payers according to insurance requirements. Analyzes claims for errors during all stages of submission for accuracy of billing. Maintains current knowledge of payer requirements Demonstrates comprehensive understanding of team functions and specialized terminology of third-party payers. Works closely with appropriate staff/departments to make corrections and ensures accuracy for the days' work (ex: coding and patient access: CCI edits, Medical Unlikely edits, demographic information, date of birth, etc). Resolves all Return to Provider (RTP) claims in error in the Medicare Fiscal Intermediary Shared System (FISS) on a daily basis (hospital only). Resolves New Jersey Discharge Data Collection System (NJDDCS) MIDS errors on a routine basis as defined by management (hospital only). Verifies covered days (hospital) and services to be rendered (hospital/professional) prior to submitting claims in a timely manner. Corrects errors from the daily claim (277) rejections or escalates to the appropriate department for resolution. Reviews hospital billing reports for corrections needed in order to have the accounts final bill - these includes but are not limited to: Late Charge report, 72-hour report, etc. to ensure claims are billed timely and accurately (hospital only). Evaluates, reviews, and analyzes patient accounts to determine if third party payments have been received, recorded, and are appropriate based on contractual expectations. Review patient's account in totality, including demographic information, service rendered, insurances documentation, etc to gain full understanding of the patient's A/R. Performs appropriate follow-up which could include calls to payers, claim review on payer portal, manual adjustment to account balance and financial class changes, where relevant. Answers calls and other inquiries from payer representative timely regarding accounts and completes proper documentation of all activity on each account. Identifies and communicates payment variances, error trends, and account issues for resolution to management. Identifies denial trends and reports them to management to allow for more efficient billing and timely resolution. Reviews credit balances for adjustments, refund and/or claim adjustment submission as assigned. Researches and retrieves appropriate documentation (e.g. authorizations, medical records) for appealing denials. Works correspondence as assigned and escalated by correspondence team. Communicates denials and other issues with the appropriate Revenue Cycle