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
High School Diploma or GED (Required)
Associate's Degree - Associates Degree / Healthcare Billing
Vocational Training (Preferred)
Minimum Work Experience
2 years - Hospital billing or related education (Required)
5 years - Hospital billing, collections and coding
Analytical problem solver, detail oriented, efficient, and
Ability to process large volumes on a daily basis.
Accurate and Expediant Typing.
Web Search. Excel, Word.
Good communication skills both verbal and written.
Understanding of managed care contracts and insurance
Detail oriented with excellent organizational skills.
Fast paced - productivity driven with emphasis on quality.
Knowledge of hospital service billing / CPT/ ICD coding.
Monitor 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.
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
Coordinate supporting documents to ensure validity for services
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
- Stay abreast of payer updates on at least a quarterly basis and
shares changes with Leadership and Team.
Claim Corrections and Billing
Research 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.