Full-Time AR Hospital Billing Specialist

Job FOCUS:

This position is responsible for Billing, Re-Billing, Post-payment and Account Follow-up and/or grievance preparation of assigned Client EMR Accounts Receivable. The responsibilities may include account maintenance of specialized or multiple payers including state and federal government programs, managed care, commercial and other insurance groups. Partners with other team members and health plans to facilitate the appropriate and prompt payment of claims. This individual must demonstrate a commitment to the organization's strategic plans, short and long-term goals and mission, vision and values by representing the company in a caring and professional manner.

Primary / Essential Expectations For Success:

The Primary responsibilities and essential job duties effectively and efficiently performed include but are not limited to the following:

BILLING

• Reviews and/or scrubs final billed initial claims for accuracy and completeness prior to submitting to payer
• Calculates Tier, Outlier, DRG and/or other Fee Schedule based reimbursement
• Submits electronic and/or hard copy claims with any attachments as per the contract timely filing criteria
• Documents all account activity in the hospital system and The Q with clear and concise notes

INSURANCE FOLLOW-UP

• Within appropriate timeframes, contact the health plan by phone or website to determine status of claim
• Documents all follow-up actions in the hospital account notes and database and sets up account for additional review based on client expectations for follow-up of unresolved accounts

POST PAYMENT REVIEW

• Researches and validates the paid or partially paid claim status is in accordance with the expectations outlined in the client contract agreement
• Deliberately and thoroughly reviews any denied, dis-allowed, or non-covered claims / charges and determines accuracy based on contract language
• Resolves any technical issues when warranted with payer
• Follows client specific procedures to request adjustments and refunds
• Prepares appeal and necessary documentation for authorization, coding, level of care and/or length of stay denials
• Follow guidelines for prioritization and timely filing deadlines

Physical / Mental Demands, Environment:

• Prolonged periods of sitting at a desk and working on a computer
• Must be able to lift 15 pounds at one time
• Must be able to structure your home office to ensure patient information is secure meeting the regulatory expectations

Skills Needed to Be Successful:

• Maintains compliance with regulations and laws applicable to job
• Professional level of communication with video, phone and email
• Ability to effectively prioritize the work to meet deadlines and expectations
• Meets the quality and productivity measures as outlined by Quadris
• Brings positive energy to work
• Uses critical thinking skills
• Being present and focused on assigned tasks and eliminates distractions
• Being a self-starter
• Ability to work independently and within a team atmosphere

Core Talent Essentials:

• High School diploma or equivalent
• 2+ years previous experience in healthcare revenue cycle management preferred
• Ability to work independently and within a team atmosphere
• Advanced proficiency of CPT and ICD-10, and full-scope revenue cycle management framework
• Self-motivated and passionate about our mission and values of quality work
• Must have professional level skills in MS products such as Excel, Word, Power Point.
• Proficient application of business/office standard processes and technical applications

Certifications:

• Active national certification CRCR through Healthcare Finance Management Organization (HFMA), or can test successfully for the certification within 6 months from hire date