Billing Specialist

Summary:
Under general supervision of the Billing Manager performs insurance/billing clerical duties including review and verification of patient account information against insurance program specifications. May resolve routine patient billing inquiries and problems follow up on balances due from insurance companies and type invoices to insurance companies. May enter data electronically to process charges payments denials and adjustments. May analyze surgical procedures and diagnosis using ICD-9 & CPT-4 codes. Responsible for compliance related to third party billing; analyzes and resolves medical necessity issues.

 

Responsibilities:
Review federal and state documentation for changes in billing regulations. Perform posting and/or reconciliation of numerical data or departmental and/or hospital accounting records. May process patient bills to various insurance companies and social welfare programs according to established billing procedures. Review patient accounting records and documents to verify accuracy of charges and third party information and initiate corrections. May calculate bills manually using detail bills.



Performs insurance billing duties/enter/edit/view claims in system including review and verification of patient account information against insurance program specifications. Ability to identify source of entry in complex multi facility organization.



Analyze and resolve problems with coding of surgical procedures and diagnosis using ICD-9 CPT-4 and HCPC coding.



Effective interpersonal and communication skills required. Self-driven results oriented with positive outlook. Ability to develop and maintain effective working relationships with staff.



Act as liaison and attend meetings with both internal and external departments when necessary to perform duties and aid in organization development.



Maintain productivity measures and accuracy standards defined by department.



Review reports charts records and/or bills that were prepared or assembled by others in order to ensure that calculations are correct. Contact other departments or personnel as necessary to resolve errors and omissions.



May download bills from mainframe system to claims editing system; translate claims submit electronic and paper billing daily. Utilize variety of system necessary to resolve problems.



Participate in educational programs and in-service meetings.



May operate one or more standard and/or automated office machinery such as on-line computer terminal calculator fax machine photocopier and microfilm viewer.



May participate in training of new employees.



Maintain quality assurance safety environmental and infection control in accordance with established policies procedures and objectives.



Perform other related duties as required.

 

Other information:
BASIC KNOWLEDGE:

High School diploma with proficiency in use of MS Office 2000 or later particularly Excel and Word.



EXPERIENCE:

One - two years' experience in health care/patient accounting or relevant setting; or equivalent combination of training and relevant work experience.



Work is performed in a typical office setting requiring extended periods of sitting

 

Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status.   Lifespan is a VEVRAA Federal Contractor.

 

Location: Corporate Headquarters USA:RI:Providence

 

Work Type: Full Time

 

Shift: 1

 

Union: Non-Union