Hospital Billing Specialist

Overview

Under general supervision, the Hospital Billing and Follow-Up Specialist handles essential billing and insurance follow-up functions. This role requires a fundamental understanding of insurance claim processing, knowledge of UB and HCFA claim forms, and the ability to interpret insurance explanation of benefits (EOBs), handle denials, and perform follow-up with insurers to ensure claims resolution. The position encompasses business office responsibilities related to patient accounts, including charge import, diagnostics and procedural coding,and claim follow-up with third-party payers to achieve a zero-balance resolution.

This position has the possibility of being hybrid schedule or remote after 6 months, per mgrs. discretion.

• Promote the mission, vision, and values of the organization.
• Import charges from queues in a timely manner and append modifiers or any required information for claim transmission.
• Review daily accounts that are ready to be billed in Waystar from Meditech.
• Initiate correction on all claims with errors by the designated time.
• Follow up on any correspondence that may have been received on that day or the previous day.
• Cross train on billing all lines of business to the different payers.
• Pull listing of all accounts assigned to be followed up by specific payer.
• Perform diagnostic and procedural coding.

• Responsible for the resubmission of primary, secondary, and tertiary claims per respective regulations and policies.
• Communicate with third-party representatives as necessary to complete claims processing and/or resolve problem claims.
• Follow up daily on post-processing activity including, but not limited to, rejected billings, adjustments, rebilling, and denied claims for accounts.
• Maintain accounts receivable detail of assigned accounts through tasking.
• Maintain standards per payer for percentage of accounts greater than 90 days.
• Work minimum standard number of accounts per payer per day.
• Meet or exceed collection goals by payer each month.
• Work all assigned accounts as assigned, depending on balance.
• Participate in educational activities and attend monthly department staff meetings.
• Maintain confidentiality and adhere to all HIPAA guidelines and regulations.
• Attend educational activities and monthly department staff meetings.
• Perform other duties as assigned from time to time.
• Perform other duties as assigned.

• High School Diploma or GED

• Six months previous experience in hospital registration, billing and collections, financial counseling, or customer service preferred.

• Knowledge of medical terminology preferred.
• Basic computer proficiency.
• Typing speed: minimum 40 WPM.
• Familiarity with CPT and ICD-9 coding is helpful.
• Good written and verbal communication skills are essential for account follow-up.