Hospital Billing Representative
The Hospital Billing Specialist will be responsible to ensure hospital claims are complete, accurate and billed within the expected time frame according to internal billing policy, Federal and State regulations and Managed Care contract guidelines.
Will be well-versed in HIP AA standards, NCCI coding and billing regulations for hospital service claims to include hospital, specialty and primary care based services.
Will develop a detailed understanding of assigned managed care contractor and payor requirements.
Will track and report billing trends with assigned carriers.
Qualifications:
Minimum EducationHigh School Diploma or GED (Required)Associate's Degree Associates Degree / Healthcare Billing Vocational Training (Preferred)Minimum Work Experience2 years Hospital billing or related education (Required)5 years Hospital billing, collections and coding (Preferred)Required Skills/KnowledgeAnalytical problem solver, detail oriented, efficient, and productivity driven.
Ability to process large volumes on a daily basis.
Computer Skills.
Accurate and Expediant Typing.
Web Search.
Excel, Word.
Good communication skills both verbal and written.
Understanding of managed care contracts and insurance compliance.
Detail oriented with excellent organizational skills.
Fast paced - productivity driven with emphasis on quality.
Knowledge of hospital service billing / CPT/ ICD coding.
Required Licenses and Certifications Hospital Coding and/or Billing Certification (Required)Functional AccountabilitiesQueue ManagementMonitor Claims Outstanding Report daily using various sorts to manage daily claim volumes and timelines according to policy.
Monitor claim errors by Form and report trends, new incidents, duplications, incorrect payer mix and unusual volumes.
Productivity Research and take action on all failed claims to bill or pend on hold for additional information by the end of the import day.
Follow-up and resolve claims in Held status daily.
Bill secondary claims no less than twice a week - Maintain age less than 5 days from import.
150 to 200 claims addressed per day contingent on assignment.
QualityCoordinate supporting documents to ensure validity for services billed.
Audit claim details for standard claim data prior to submission to ensure accuracy and complete edit satisfaction.
Follow written procedure, payer policy , guidelines and edit instruction completelyStay abreast of payer updates on at least a quarterly basis and shares changes with Leadership and Team.
Claim Corrections and BillingResearch coding errors using CPT and ICD guidelines, Craneware and NCCI tools, Medical Records and Account Systems.
Following procedure pursue authorization for code corrections.
Apply data corrections to claim and/or host systems performing transaction updates/same claim or charge corrections/new claim as outlined in procedures.
Apply claim notes to provide detailed explanation to downstream users when claims are pending corrections (Held claim) or not billed (Archive/Del).
Document the:
(1) Problem, (2) Research, (2) Findings, (3) Action Taken, (4) FU plan Coordinate submission of supporting documentation, e.
g.
, treatment plans, operative reports, EOB.
Organizational AccountabilitiesOrganizational Accountabilities (Staff)Organizational Commitment/Identification Anticipate and responds to customer needs; follows up until needs are metTeamwork/Communication Demonstrate collaborative and respectful behaviorPartner with all team members to achieve goalsReceptive to others' ideas and opinionsPerformance Improvement/Problem-solving Contribute to a positive work environmentDemonstrate flexibility and willingness to changeIdentify opportunities to improve clinical and administrative processesMake appropriate decisions, using sound judgmentCost Management/Financial Responsibility Use resources efficientlySearch for less costly ways of doing thingsSafety Speak up when team members appear to exhibit unsafe behavior or performanceContinuously validate and verify information needed for decision making or documentationStop in the face of uncertainty and takes time to resolve the situationDemonstrate accurate, clear and timely verbal and written communicationActively promote safety for patients, families, visitors and co-workersAttend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance Recommended Skills Administration Analytical Attention To Detail Auditing Billing Claim Processing Estimated Salary: $20 to $28 per hour based on qualifications.
Will be well-versed in HIP AA standards, NCCI coding and billing regulations for hospital service claims to include hospital, specialty and primary care based services.
Will develop a detailed understanding of assigned managed care contractor and payor requirements.
Will track and report billing trends with assigned carriers.
Qualifications:
Minimum EducationHigh School Diploma or GED (Required)Associate's Degree Associates Degree / Healthcare Billing Vocational Training (Preferred)Minimum Work Experience2 years Hospital billing or related education (Required)5 years Hospital billing, collections and coding (Preferred)Required Skills/KnowledgeAnalytical problem solver, detail oriented, efficient, and productivity driven.
Ability to process large volumes on a daily basis.
Computer Skills.
Accurate and Expediant Typing.
Web Search.
Excel, Word.
Good communication skills both verbal and written.
Understanding of managed care contracts and insurance compliance.
Detail oriented with excellent organizational skills.
Fast paced - productivity driven with emphasis on quality.
Knowledge of hospital service billing / CPT/ ICD coding.
Required Licenses and Certifications Hospital Coding and/or Billing Certification (Required)Functional AccountabilitiesQueue ManagementMonitor Claims Outstanding Report daily using various sorts to manage daily claim volumes and timelines according to policy.
Monitor claim errors by Form and report trends, new incidents, duplications, incorrect payer mix and unusual volumes.
Productivity Research and take action on all failed claims to bill or pend on hold for additional information by the end of the import day.
Follow-up and resolve claims in Held status daily.
Bill secondary claims no less than twice a week - Maintain age less than 5 days from import.
150 to 200 claims addressed per day contingent on assignment.
QualityCoordinate supporting documents to ensure validity for services billed.
Audit claim details for standard claim data prior to submission to ensure accuracy and complete edit satisfaction.
Follow written procedure, payer policy , guidelines and edit instruction completelyStay abreast of payer updates on at least a quarterly basis and shares changes with Leadership and Team.
Claim Corrections and BillingResearch coding errors using CPT and ICD guidelines, Craneware and NCCI tools, Medical Records and Account Systems.
Following procedure pursue authorization for code corrections.
Apply data corrections to claim and/or host systems performing transaction updates/same claim or charge corrections/new claim as outlined in procedures.
Apply claim notes to provide detailed explanation to downstream users when claims are pending corrections (Held claim) or not billed (Archive/Del).
Document the:
(1) Problem, (2) Research, (2) Findings, (3) Action Taken, (4) FU plan Coordinate submission of supporting documentation, e.
g.
, treatment plans, operative reports, EOB.
Organizational AccountabilitiesOrganizational Accountabilities (Staff)Organizational Commitment/Identification Anticipate and responds to customer needs; follows up until needs are metTeamwork/Communication Demonstrate collaborative and respectful behaviorPartner with all team members to achieve goalsReceptive to others' ideas and opinionsPerformance Improvement/Problem-solving Contribute to a positive work environmentDemonstrate flexibility and willingness to changeIdentify opportunities to improve clinical and administrative processesMake appropriate decisions, using sound judgmentCost Management/Financial Responsibility Use resources efficientlySearch for less costly ways of doing thingsSafety Speak up when team members appear to exhibit unsafe behavior or performanceContinuously validate and verify information needed for decision making or documentationStop in the face of uncertainty and takes time to resolve the situationDemonstrate accurate, clear and timely verbal and written communicationActively promote safety for patients, families, visitors and co-workersAttend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance Recommended Skills Administration Analytical Attention To Detail Auditing Billing Claim Processing Estimated Salary: $20 to $28 per hour based on qualifications.
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