GIRMC Hospital Billing Specialist

GENERAL SUMMARY:

Responsible for the accurate submission of claims to Medicare, Medicaid and all third-party payers according to GIRMC compliance policies and federal billing regulations to ensure timely and accurate payment. In addition to submitting claims to primary payers, this role is responsible for claim re-submissions and re-works, claim communications, reconsiderations and appeals. Ensures that Medical Center compliance standards are supported and works closely with Medical Center personnel, medical staff, payer contacts, outside agencies, patients and family members as needed.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

2. *Reviews and analyzes all erred claims for correct and complete patient and insurance information, service dates and charges.

3. *Ensures all billing forms are completed and are accurate based on billing regulations for all payers to ensure appropriate and timely reimbursements are received and all compliance standards are maintained.

4. *Analyzes all outstanding unbilled claims and reports any concerns to the manager or director.

5. *Maintains knowledge of current billing guidelines and third-party payer regulations.

6. *Responsible for processing returned claims and rework requests for information and filing resubmissions or appeals as necessary.

7. *Reviews assigned credit balances for appropriate refund or adjustment process and reviews refund requests from payer for a refund or appeal if GIRMC disputes the refund request.

8. *Reviews work queues for insurance updates; applies appropriate coverages to patient visits and ensures accuracy of billing; which may include access to Insurance Websites and lengthy phone calls for review and dispute of claims.

9. Organizes and scans patient financial services documents.

10. Performs timely follow-up of all outstanding claims and takes the appropriate action to ensure accurate reimbursements.

11. *Works claim edits and rejections daily to ensure timely and accurate reimbursement.

12. *Investigates reason for errors by communicating with specified department personnel and makes the necessary corrections within the system.

13. *Actively researches State and Federal regulations and billing guidelines to stay current, ensuring compliance.

14. *Reviews late charges/credits; and where appropriate requests claim re-bill to complete billing process.

15. *Contacts patients or employers as necessary for correct health plan information by calling or sending correspondence as needed.

16. Follows GIRMC protocols in communicating and releasing patient information.

17. Communicates new processes or changes in Medicare, Medicaid and third party billing documentation requirements to co-workers, to include legal compliance information.

18. Reviews WQ's for insurance updates; applies appropriate coverages to patient visits and ensures accuracy of billing.

19. Answers patient phone calls and questions as in but not limited to, request for itemized billing statements, updating insurance information, accuracy of billing statement, etc.

20. Retrieves voicemails and emails daily from GIRMC Patient Accounts email/voicemail and resolves the inquiry.

21. Takes patient payments for Meditech accounts for payment plans.

22. Works directly with collection agencies on bad debt accounts.

23. Reviews billing statements from Meditech for errors.

24. Works in Electronic Medical Record (EMR) systems daily.

25. Works daily in the Assurance system for claim submission.

26. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.

27. Participates in meetings, committees and department projects as assigned.

28. Performs other related projects and duties as assigned.

EDUCATION AND EXPERIENCE:

High school diploma or equivalency required. Associates degree in business or accounting related field preferred. Two (2) years' experience in patient billing or other medical-related patient accounts experience required. Experience as a governmental biller in a hospital setting preferred. Training or prior experience in CPT/ICD-10 coding desired. Must be at least 19 years of age to witness legal consents.