WHMG Billing Specialist
- - Wilson Health Medical Group
- Sidney, OH, USA
- Full Time
Under the direction of the Billing Services Administrator, the Physician Billing Specialist is expected to work as an integral part of the team. Possess strong ethical and moral judgment and decision making, and uphold the hospital's Core Values ~ ASPIRE ~ Always Serve with Professionalism, Integrity, Respect and Excellence.
ESSENTIAL DUTIES AND RESPONSIBILITIES: includes the following. Other duties may be assigned.
- Develop and maintain a cooperative, professional relationship with network and hospital organization. Effectively present information and respond to questions from co-workers, patients', patient's families, outside agencies, the general public and physicians.
- Verify accuracy of captured revenue, collections and patient financial information on a daily basis of assigned offices, this includes but not limited to CPT, ICD9 coding, co-pay collected and insurance data gathered.
- Identify, track and make corrections as necessary in tandem with the office professional. Provide feedback of reoccurring issues to the team leader of low quality results for educational follow up.
- Responsible for daily assignment of manual and/or electronic payment and denial posting, while making accurate and appropriate contractual adjustments to governmental, managed care and commercial clams.
- Assist in monitoring contracted payments regularly through payment posting for discrepancies, and report to the Billing Services Administrator for appropriate follow up.
- Efficient utilization of Navicure and Office Manager for follow up on assigned claims that are partially or unpaid over 45 days. Follow up includes but not limited to insurance reviews, phone or paper, refunds, necessary research to ensure complete resolution of claim payment.
- Shared responsibility with co-workers of:
- Bank Run and mail pick up two times a week, or as needed
- Daily claims validation, preparation of electronically and paper, to bill for reimbursement
- Working the held claim list
- Preparing payment batches for posting the following day
- Participation in ongoing training, 360 degree feedback survey and other programs to improve on going quality of the department and organization.
QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions, and possess the ability to work as a team player in a professional manner and maintain confidentiality in all matters.
EDUCATION AND/OR EXPERIENCE: High school diploma or general education degree (GED); minimum of one year experience and/or training in medical billing field; or equivalent combination of education and experience.
LANGUAGE SKILLS: Ability to read and comprehend simple instructions, short correspondence and memos, and effectively communicate both orally and in writing to present information to customers, clients, and other employees in the organization. This would include the following population: pediatric, adolescent, young-middle aged adult and geriatric.
OTHER SKILLS AND ABILITIES: Accurate typing, calculator and strong computer skills and experience, understanding and use of medical terminology, CPT and ICD-9 coding, ability to work in a highly stressful environment and have strong customer service and organizational skills.
PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is frequently required to sit; and talk or hear. The employee is occasionally required to stand; walk; and reach with hands and arms.
The employee must frequently lift up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.