Insurance Billing Specialist, Patient Financial Services

Overview

WHAT IT'S LIKE AT SGMC HEALTH

Description

WHAT IT'S LIKE AT SGMC HEALTH

Purpose
. No matter your role or area that you work in, at SGMC Health we are collectively working towards goals that will make our community a better place.

Excellence
. We strive to do the right thing the right way, are accountable in all we do, require competence of our people, and are compassionate in our service.

Team Spirit
. We encourage team effort, support personal and professional development, acknowledge individual talents and skills, and support innovation and empowerment.

Award Winning Performance
. We are committed to providing the best care possible and we are proud to be recognized locally, statewide, and nationally for the exceptional care that our staff provides.

Benefits

SGMC has great benefit options, depending on the role that you are going into– including healthcare, supplementary benefits, ways to save for the future, opportunities for career advancement, and opportunities to expand your skill set. Some of these great benefit options are listed below:

• Low Healthcare Insurance Premiums
• 401(k) with employer match
• Paid Time Off (PTO)
• Employee discounts
• Company paid life insurance
• Short-Term and Long-Term Disability
• Cancer Insurance
• Accident Insurance
• Pet Insurance
• Tuition Reimbursement
• On-the-job training and skills development
• Opportunities for growth and advancement
• Employee Assistance Program

JOB LOCATION
: SGMC Patient Financial Services

DEPARTMENT
: PATIENT FINANCIAL SERVICES

SCHEDULE
:
Full Time, 8 HR Day Shift

Responsible for processing incoming requests from various departments to bill manual and electronic claims to ensure timely and complete collection of all dollars assigned. Verifying patients’ insurance coverage. Answering billing questions from internal and external customers. Responsible for the timely billing, correction of edits, follow up of unpaid balances, and appealing of denials of hospital charges. Verifying patient’s insurance coverage and benefits.

Answering billing questions from internal and external sources. Responsible for subset of payers and/or alpha split of payer groupings. Will be accountable for the overall health of the accounts receivables assigned. Responsible for daily review of correspondence, outstanding insurance credit balances, over-posted account balances, and paid claims with outstanding balances.

• Prior hospital billing experience recommended.
• Compiles attachments, corrects claim edits, updates and bills on a daily basis all claims received from the electronic system.
• Submits claims in Epic HB Resolute Billing system.
• Documents and updates status of unpaid insurance balances.
• Researches and analyzes various billing reference manuals to review billing accuracy.
• Documents electronic system regarding returned faxes and Certified Return Receipts. Completes production logs. Processes outgoing mail.
• Verifies Medicare, Medicaid, and other 3rd Party eligibility using various systems.
• Technical/system skills/knowledge: PC and Windows literacy required; knowledge of Medicare, Medicaid, and other payer web portals, Craneware, Microsoft Office applications, and Experian claim source clearinghouse portal preferred.
• Extensive knowledge of insurance/managed care, to include:
  Medicare;
  Medicaid (Georgia and Florida);
  Peach State;
  Wellcare;
  Care Source;
  Amerigroup;
  Tricare (Standard, Extra and Prime); VA;
  Disability Adjudication Services;
  Vocational Rehabilitation;
  Children’s Medical Services;
  Cancer State Aid;
  Crime Victim’s Compensation Program;
  Knight’s Templar Eye Foundation;
  Managed Care (HMO, PPO, POS, Medicare HMO); COBRA;
  Worker’s Compensation;
  Blue Cross (Georgia, Florida, out-of-state and FEP); and Institutional Billing.
• Working knowledge of CPT-4, HCPCS, and ICD-10.
• Knowledgeable of insurance and reimbursement process.
• Must have a thorough understanding and knowledge of: patient type; financial class; insurance master; place of service codes; relationship codes; accommodation, occurrence, value and condition codes.
• Related regulatory and legal requirements:
  Medicare Secondary Payer Questions; medical necessity;
  Medical…