Hospital Account Billing Specialist

Under direct supervision, performs highly responsible work involving expediting the accurate and timely preparation and submission of insurance claims to third‑party carriers and intermediaries, and answers related inquiries according to hospital written procedures.

Supervision received takes the form of discussions, conferences and review of work for conformity with established laws, rules and regulations.

• Maintains and controls unbilled insurance files for a given section of patients accounts.
• Reviews files daily and spot checks final bills for accuracy and readiness of billings.
• Processes bills for ambulance and outpatients clinic services.
• Prepares and submits claims to carriers and intermediaries after all information is available for billing.
• Files patients records.
• Prepares and submits a daily listing of all un‑billable claims.
• Assists in the collection of cash for services performed when the cashier is absent.
• Prepares daily input forms to be submitted to Data Processing relative to billing function.
• Prepares daily billing report.
• Performs other related duties as required.

Graduation from a recognized college or university with a major in business administration or related field.

High School Diploma or equivalent, plus four years responsible working experience with hospital insurance billing or with a major carrier in the claims processing area.

• Knowledge of filing practices and procedures.
• Knowledge of insurance claims processing.
• Knowledge of basic mathematics.
• Knowledge of business office procedures and hospital policies.
• Knowledge of the use of adding machines and/or calculators.
• Ability to type at least 50 words per minute.
• Ability to operate "on‑line" input terminal equipment.
• Ability to prepare accurate reports.
• Ability to express oneself clearly and concisely orally and in writing.
• Ability to establish and maintain good working relationships with all concerned during the course of work.

Direct supervision is exercised by a higher level official who gives specific work assignments and checks work upon its completion. Routine work is performed independently following set procedures; work is reviewed for accuracy and completeness.

Guidelines consist of established hospital guidelines, practices and procedures; due to the recurring nature of the duties performed instructions are easily memorized and little interpretation is necessary. When instructions do not apply, the problem is referred to the supervisor.

Work involves responsibility for preparation and submission of accurate and timely insurance claims to third‑party carriers and intermediaries; responding to inquiries; preparing lists of unbillable claims and preparing daily reports; usually the work is clear‑cut and generally applies directly to the problem or issue at hand.

The purpose of the work is to facilitate the timely processing of insurance claims so that the hospital can receive payment on patient account balances. Prompt payment of outstanding balances enables the hospital to efficiently run its daily operations.

Contacts are with co‑workers, hospital employees, patients, as well as third‑party carriers and can be face to face, via telephone or in writing.

The personal contacts involve exchange of information regarding claim filing procedures, billing addresses and other pertinent patient related information.

Work is mostly sedentary, however, some walking, bending, and lifting is required to retrieve files and process paperwork.

Work is performed in an office setting.