The Insurance Claim Billing Specialist 's main focus is to obtain maximum and appropriate reimbursement for all claims from third party payers. The Insurance Claim Billing Specialist is responsible for preparing and submitting timely and accurate insurance claims to third party payers, assisting in the implementation of payer regulations and ensuring compliance to the regulatory requirements, and verifying payments and adjustments are appropriately applied to accounts based on government, contract or other regulations or agreements. The Insurance Claim Billing Specialist is responsible for appropriate follow up on all accounts pending payment from government and third-party payers.
High school graduate or equivalent required.
Completion of program in medical billing degree or certification program
LICENSURE and CERTIFICATION
One year of previous office experience
Prior healthcare clinic/hospital billing experience of 2 years is preferred.
KNOWLEDGE OF, SKILLS IN, ABILITY TO, COMPLEXITY AND DIFFICULY:
Personal computers, hardware and basic software programs including e-mail, word processing and spreadsheet.
HIPAA and confidentiality requirements.
Third party and governmental billing requirements and contracts.
Office procedures, record and bookkeeping practices.
Advanced oral and written communication skills.
Establish and maintain collaborative relationships
Work effectively in a team environment
Work independently with minimal supervision
Remain organized and focused when dealing with frequent interruptions and competing priorities
Respond calmly and effectively to sensitive and difficult situations
Concentrate and pay close attention to details
Utilize time management concepts and maximize time effectively
Maintain flexibility to adapt to a variety of work load assignments
Interpret policies and procedures, identify non-compliance and take appropriate action
Work with numbers and perform basic to complex mathematics
Analyze accounts and compare to contracts, agreements and government regulations.
Refer to policy manual for specific instructions/guidelines. Follow established policies and Procedures.
Adhere to the standards of the job description and overall philosophy of Bozeman Deaconess Hospital
Maintain flexibility to adapt to a variety of workload assignments.
COMPLEXITY AND DIFFICULTY:
Work independently with a minimum of supervision
Position requires high degree of confidentiality due to access of financial and medical information
Complexity of duties comes in understanding the policies and procedures, which change with great frequency, to make independent decisions that will not jeopardize the collect ability or amount received by Bozeman Deaconess and for prioritizing the work volumes appropriately.
Concentration on organization since this position handles a large volume of paper work.
Concentration on detail when dealing with numbers and mathematical calculations where errors are critical to our customers and our business.
A complete understanding of Bozeman Deaconess charges, billing structures and the rationale behind them so appropriate answers can be given to the customer, public, and third parties.
A thorough understanding of the laws governing authorized signatures, release of information, and release of diagnosis, disclosure regulation and billing and collection authority.
Concentration as the job requires high productivity, yet has many and frequent interruption factors including telephone calls.
A thorough understanding of contracts, arrangements, agreements and government regulations that govern insurance claims to ensure compliance and proper reimbursement.
Errors are costly to Bozeman Deaconess to the extent of financial loss and damaging customer's attitude toward the facility.
- 40% Time Spent - Responsible for submission of timely and accurate claims to primary, secondary, and tertiary insurances for both electronic and paper submission. Generates telephone calls to insurance carriers to follow up on claims using electronic worklist and reports generated for this purpose. Follows up on all unpaid claims through phone contact or written correspondence to ensure that no account reaches 180 days old from discharge date and still due by insurance.
- 30% Time Spent - Audits accounts by verifying that reimbursement amounts are appropriate, coordination of refunds, if appropriate, and coordinating adjustments when necessary, claims appeals or resubmissions, moving balances from insurance responsibility to patient responsibility when appropriate, and reviews and resolves credit balances
- 10% Time Spent - Ensure that claims have appropriate information on them for submission to insurance companies or agencies by reviewing errors and other prebilling insurance reports/worklists. Analyzes and review claims to ensure that payer specific regulations and requirements are met.
- 10% Time Spent - Help patients with questions regarding their hospital bills in any way that is satisfactory to the patient.
Bozeman Deaconess Hospital