Revenue Cycle Billing Specialist - FT - Day - MSO​/Centralized Billing Lawrenceville NJ

Pay Range

$19.32 - $24.13

40

Responsible for all aspects of claim submission for services rendered at Capital Health through the Revenue Cycle life cycle to all payers, including but not limited to pre and post claim review, claim (277) rejections, denial review, and claim resubmission. Provides, elicits, and gathers information to facilitate, expedite, and obtain professional payments from third party carriers. Performs collection and follow‐up activity with insurance companies.

Completes necessary billing projects as assigned. Meets internal and external customer expectations.

Education:

High school diploma or equivalent.

Experience:

One year of previous healthcare billing experience in a hospital, professional, or medical office setting.

Knowledge and

Skills:

Special Training:
Working knowledge of Microsoft Office and Excel. Experience using Electronic Medical Record (EMR) software. Cerner, Athena, Epic preferred.
Mental, Behavioral and Emotional Abilities:
Can work well independently and in team settings.
Usual Work Day: 8 Hours

Does this position formally supervise employees? No

Responsible for all primary and secondary claims submitted to payers according to insurance requirements.
Analyzes claims for errors during all stages of submission for accuracy of billing. Maintains current knowledge of payer requirements.
Demonstrates comprehensive understanding of team functions and specialized terminology of third‑party payers.
Works closely with appropriate staff/departments to make corrections and ensures accuracy for the day’s work (ex: coding and patient access: CCI edits, Medical Unlikely edits, demographic information, date of birth, etc).
Resolves all Return to Provider (RTP) claims in error in the Medicare Fiscal Intermediary Shared System (FISS) on a daily basis (hospital only). Resolves New Jersey Discharge Data Collection System (NJDDCS) MIDS errors on a routine basis as defined by management (hospital only).
Verifies covered days (hospital) and services to be rendered (hospital/professional) prior to submitting claims in a timely manner. Corrects errors from the daily claim (277) rejections or escalates to the appropriate department for resolution.
Reviews hospital billing reports for corrections needed in order to have the accounts final bill – these includes but are not limited to:
Late Charge report, 72‑hour report, etc. to ensure claims are billed timely and accurately (hospital only).
Evaluates, reviews, and analyzes patient accounts to determine if third‑party payments have been received, recorded, and are appropriate based on contractual expectations. Review patient’s account in totality, including demographic information, services rendered, insurance documentation, etc to gain full understanding of the patient’s A/R.
Performs appropriate follow‑up which could include calls to payers, claim review on payer portal, manual adjustment to account balance and financial class changes, where relevant. Answers calls and other inquiries from payer representative timely regarding accounts and completes proper documentation of all activity on each account.
Identifies and communicates payment variances, error trends, and account issues for resolution to management. Identifies denial trends and reports them to management to allow for more efficient billing and timely resolution.
Reviews credit balances for adjustments, refund and/or claim adjustment submission as assigned. Researches and retrieves appropriate documentation (e.g., authorizations, medical records) for appealing denials.
Works correspondence as assigned and escalated by correspondence team. Communicates denials and other issues with the appropriate Revenue Cycle department and/or physician representative to address root causes.
Documents clear and concise notes in the billing system. Operates other relevant computer software efficiently to complete required billing and follow‑up tasks.
Enters charges into Billing System from various reports, where relevant. Performs assigned worklists and other duties quickly and accurately…