CRMG Billing Specialist
Cheyenne Regional Medical Center
- Cheyenne, WY
- Permanent
- Full-time
- 403(b) with 4% employer match
- ANCC Magnet Hospital
- 21 PTO days per year (increases with tenure)
- Education Assistance Program
- Employee Sponsored Wellness Program
- Employee Assistance Program
- Loan Forgiveness Eligible
- Pursues and participates in education for assigned payer to remain current with changes in the healthcare industry via payer websites, payer newsletters, webinar and attendance at assigned payer meetings.
- Reviews accounts each day in assigned Epic Work Queues and prioritize by dollar amount and timely filing rules to achieve the best possible reimbursement.
- Completes necessary research to submit claims to appropriate payer based on coordination of benefits and active coverage at time service was rendered.
- Evaluates payer remittance advice and/or explanation of benefits on denials for accuracy according to individual payer contracts.
- Maintains knowledge of Medicare, Medicaid, and all commercial insurance programs, including Medicare HMO’s and State Programs to include filing deadlines, billing requirements, and reimbursement methods.
- Composes and submits appeals to third party payers, appealing to the highest level to resolve account denial for proper reimbursement.
- Receives and researches patient, payer, attorney, and third party inquiries received through incoming calls and correspondence in a timely manner by reviewing all available information including payer remits, contracts, documentation, policies and procedures, and insurance laws to formulate an informative response and direct the account appropriately.
- Maintains or exceeds performance metrics according to job assignment focusing on reduction to Accounts Receivable Days and Denial Rates.
- Provides feedback to management on denial trends and claim edits to assist with process improvement and quality assurance within our billing software.
- Provides exemplary customer service and demonstrate positive communication skills in a courteous, accurate and honest manner.
- Knowledge and understanding of Federal and State billing and coding regulations and compliance
- Knowledge and understanding of HIPAA
- Ability to multitask with a high attention to detail
- Must have the ability to type a minimum of 40 wpm
- Ability to handle cash
- Knowledge of medical terminology and coding
- High school diploma (or Equivalent Certificate from an accredited program) or higher degree
- Six (6) months of or more of customer service and/or monetary transaction experience
- Completion of Billing/Coding Program with Certification
- Healthcare and/or insurance billing experience
- Home care billing experience