The specialist is responsible for submitting and resolving medical claims of moderate to high complexity while maintaining accurate patient and physician records. They act as a liaison to resolve outstanding account balances and insurance denials through effective communication and follow-up.
A Brief Overview
Position responsible for submitting and resolving medical claims moderate to high complexity. Must remain current with governmental and third party billing, follow-up and appeal requirements for compliant billing and follow-up of both inpatient and outpatient claims for all wholly owned facilities and physician entities including internal and external policy requirements.
What You Will Do
Responds to requests from management, staff, or physicians in a timely and appropriate manner.
Maintains patient and physician confidentiality and professionalism at all times.
Follow department policies and procedures to ensure accurate and timely claim resolution.
Effectively communicates utilizing telephone, form letters, e-mail, or internal correspondence to resolve patient inquiries and insurance issues.
Attends and participates in team meetings.
Utilizes worklists to review and analyze account balances in order to collect payment for medical services rendered.
Utilizes multiple system applications to review, update patient information as well as research and resolve outstanding AR balance.
Assists in the analysis of claims resolution and provides feedback to management for solutions and process improvements.
Performs follow up with insurance companies to ensure appropriate payment on claims, resolve denials, correct claims, and appeal claims.
Acts as a liaison with internal and external customers providing assistance in claims and receivables resolution in a high volume environment.
Documents accounts with clear and concise verbiage in accordance with departmental procedures.
Reviews and responds to correspondence and inquiries received.
Meets and exceeds team productivity and quality standards.
Takes the lead on special projects.
Participates in staff training.
Reviews complex claims issues for resolution and recommends process improvements.
Performs other related duties as assigned.
Additional Responsibilities
Performs other duties as assigned.
Complies with all policies and standards.
For specific duties and responsibilities, refer to documentation provided by the department during orientation.
Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.
Education
High School Equivalent / GED (Required) and
Associate's Degree (Preferred) and
Bachelor's Degree (Preferred)
Work Experience
1+ years medical billing / claim experience (Required) and
Experience with medical billing software (Preferred)
Knowledge, Skills, & Abilities
Must have a working knowledge of claim submission (UB04/HCFA 1500) and third party payers. (Required proficiency)
Knowledge of procedural and ICD10 coding. (Required proficiency)
Basic knowledge of medical billing terminology. (Required proficiency)
Detail-oriented and organized, with good analytical and problem solving ability. (Required proficiency)
Notable client service, communication, and relationship building skills. (Required proficiency)
Ability to function independently and as a team player in a fast-paced environment. (Required proficiency)
Must have strong written and verbal communication skills. (Required proficiency)
Demonstrated ability to use PCs, Microsoft Office suite (including Word, Excel and Outlook), and general office equipment (i.e. printers, copy machine, FAX machine, etc.). (Required proficiency)
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