Billing Specialist

Job Summary

Under general supervision, is responsible for representing Roosevelt General Hospital and RGH Clinic as an exemplary hospital in the region. The Billing Specialist position requires fundamental knowledge of filing insurance claims on UB and HCFA claim form, how insurance companies pay accordingly to contracts established with the hospital, how to read and interrupt an insurance explanation of benefits (EOB), process denials, import charges and do precise follow-up with the insurance company via, phone, email, insurance web sites, etc. at an acceptable volume per day. RGH Insurance specialist will be the embodiment of the hospital's mission, vision and values. The Billing specialist will greet patients or family members upon arrival within the business office and assist them in answering any questions or concerns they may have regarding billing issues. The insurance specialist will have knowledge of all aspects of the department process from the registration process thru the billing.

Essential Functions:

Business Office (will report to Business Office Director for these functions)

• Promote the mission, vision, and values of the organization
• Responsible for all billing functions for an assigned Financial Classes (Medicaid, Medicare, Medicare Advantage, Champus, BCBS, Commercial, PPO, or Workman's Comp)
• Process account checks by applying necessary corrections for successful claims transmission
• Process incomplete, held, and rejected claims from clearinghouse on a daily basis
• Process daily tasks requiring claim follow up to ensure timely payment and denial resolution
• Process denials received electronically and on paper to ensure timely claim resolution
• Obtain necessary billing information to submit claim to correct carriers
• Process credit balances on assigned accounts
• Assist patients with billing inquiries to include explaining the charges, payments, and insurance decisions
• Follow up on any correspondence that may have been received on that day or the previous day
• Cross train in other Billing Specialist positions to include different payers
• Participate in weekly billing huddles/discussions

• Diagnostic and procedural coding

• Post payments from the different payers to patients accounts
• Enters relevant information into computer system
• Assists patients with questions concerning their insurance coverage
• Explains hospital regulations, such as visiting hours, payment of accounts, charges, etc.
• Participates in data gathering for financial reporting
• Notify all payers who require IP notification
• Greet all patients, families and hospital visitors with a positive, cheerful attitude
• Uphold the mission, vision and values of Roosevelt General Hospital (RGH)
• Be knowledgeable on all of RGH's services
• Be willing to serve as a communications person between the department and hospital

• Assist with Clinic or Hospital registration or phones, as needed

Non-Essential Functions

• Perform other duties as assigned

Professional Requirements

• Maintain patient confidentiality at all times
• Maintain professional attire
• Complete continued education/training requirements
• Report to work on time and as scheduled
• Wear identification while on duty
• Represent the organization in a positive and professional manner at all times
• Comply with all organizational policies and standards regarding ethical business practices
• Communicate the mission, ethics and goals of the organization
• Participate in performance improvement and continuous quality improvement activities

Qualifications

• High school graduate or equivalent
• Medical terminology knowledge preferred.
• Basic computer knowledge
• Typing speed: minimum 40 wpm, computer knowledge
• Six months previous hospital registration, billing and collections, financial counseling, and/or customer service experience preferred
• Knowledge of CPT / ICD-9 coding helpful.

Knowledge, Skills, and Abilities

• Must have an enthusiastic and positive attitude
• Possess a genuine desire to help RGH become an exemplary hospital in the surrounding community and the state
• Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude
• Ability to manage multiple and simultaneous responsibilities and to prioritize duties/tasks
• Ability to initiate communication with patients, their families and hospital visitors
• Must have excellent customer service and communication skills with the ability to effectively calm patients and be able to deal with distressed and/or agitated patients and their families
• Must have a professional demeanor and excellent public relations skills
• Willingness to develop or improve public speaking skills
• Knowledge of medical insurances (Medicare, HMO's, PPO's, commercial), EMTALA regulations, hospital billing and collection process
• Must have excellent written skills with knowledge of medical terminology
• Must be dependable and on time
• Possess good 'people skills' for building relationships with colleagues at all levels
• Ability to plan and prioritize your own work and other people's

Physical Requirements and Environmental Conditions

• Work is performed during regular work hours, but may require overtime and/or weekend hours to meet deadlines
• Work in varying degrees of temperature (heated or air conditioned)
• Work under extreme pressures
• Position requires sitting for approximately 4-6 hours per day and walking for 2 hours per day
• Position requires light to moderate work with 50 pounds maximum weight to lift and carry
• Position requires reaching, bending, stooping, and handling objects with hands and/or fingers, talking and/or hearing, and seeing