Billing Specialist

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Under direct supervision, performs all billing and collection functions on account balances within assigned financial classes. Ensures timely submission of all claims and timely follow up. Posts payments in EPIC. Performs eligibility, verification and authorization requests, as needed.

• High School diploma or equivalent required. Associate’s degree preferred.

• Two years of medical billing experience and one year experience with electronic billing.
• Epic experience desired.

• Thorough knowledge and understanding of medical billing, insurance and private pay.
• Knowledge of all medical billing requirements for Medicare, Blue Cross, Medical Assistance, Commercial insurance, and HMO carriers.
• Strong collection skills, including claims follow‑up and revenue cycle practices.
• Strong computer skills, including EMR knowledge and Microsoft Office. Excel preferred.
• Strong interpersonal skills.
• Excellent verbal and written communication skills for interacting with patients, families, insurance companies and healthcare providers.
• Strong ability to investigate issues, find solutions and work under pressure to resolve billing issues.
• Efficient in managing multiple tasks, prioritizing, and ensuring deadlines are met.
• Ability to handle multiple claims and billing tasks simultaneously while maintaining quality and accuracy.

N/A

• Manages assigned EPIC work queues daily to ensure accurate billing and expedient claims follow‑up.
• Ensures timely submission of all claims within assigned financial classes.
• Ensures timely follow‑up of all claims within assigned financial classes.
• Investigates claim denials or rejections.
• Completes functions in order to resolve claims.
• Uses all available tools such as online access, calling the insurance companies and working with provider representatives.
• Identifies appeals.
• Identifies secondary billing for accounts with secondary liability and follows up on any unpaid balances. Brings these claims to resolution.
• Identifies patient self‑pay balances and bills them timely. Follows up as necessary, including calling for follow‑up.
• Processes late charge claims, claim resubmissions and/or claim corrections to payors.
• Enters and posts payments to patient accounts based on remittance advice review.
• Reconciles accounts and ensures any underpayments or over payments are corrected.
• Responds to patient and third‑party payor inquiries regarding patient accounts via e‑mail, telephone, mail, and in person.
• Audits primary patient bills for submission to third‑party payers via electronic billing or manual claim submission.
• Maintains detailed and accurate billing records for auditing purposes and compliance with industry regulations.
• Maintains thorough records of all communication with insurance providers and patients regarding claims.
• Participates in meetings with Provider Representatives to resolve denial discrepancies.
• Prepares and submits appeals for denied claims, understanding additional documentation necessary to submit an appeal.
• Obtains an in‑depth understanding of hospice billing regulations and ensures compliance with federal, state and local billing laws, including HIPAA regulations.
• Prepares reports to managers recommending accounts for bad debt adjustments, maintaining lost revenue at a level of less than 1% of net healthcare revenue.
• Recommends accounts for transfer to bad debt.

• Ability to sit, concentrate and pay close attention to detail.

• Normal office environment with little exposure to excessive noise, dust, temperatures and the like.

• Treats others with fairness, kindness, and respect for personal dignity and privacy.
• Listens and responds appropriately to others’ needs, feelings, and capabilities.

• Meets and/or exceeds customer expectations.
• Actively pursues learning and self‑development.
• Pays attention to detail; follows through.

• Sets a positive, professional example for others.
• Takes ownership of problems and does what is needed to solve…