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

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

$20.10 - $26.13

40

Acts as a front‑line resource for staff inquiries, coaching, and training as it pertains to the healthcare claim submission life cycle. Has a strong understanding of all essential functions within billing department and can articulate and disseminate information to staff timely and effectively. Supports billing management and work focused projects, as well as provide feedback. 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:

Three years' previous healthcare billing experience in a hospital, professional, or medical office setting.

Knowledge and

Skills:

• Intermediate knowledge of Microsoft Office products, specifically Word and Excel.
• Proficient experience using Electronic Medical Record (EMR) software.
• Cerner, Athena, Epic preferred.

• Assists with training and onboarding of all new hires. Acts as a resource for problem solving and education for Hospital Billing Revenue Specialists.
• Communicates effectively to Leadership and identifies opportunities for improvement. Supports department performance improvement initiatives.
• Assigns worklist to billing staff and helps maintain and drive productivity standards.
• Responsible for all claims submitted to payer. Analyzes claims for errors and makes corrections prior to submission.
• Maintains current knowledge of payer requirements. Demonstrates a 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 (e.g. 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 the 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 include 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.
• 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 representatives timely regarding accounts and completes proper documentation of all activity on each account.
• Identifies…