Billing & Claims Spec 1 MGBO

5000 Wellstar Medical Group, LLC; Georgia; Hybrid; USD 52,000 - 68,000; Full time

Job summary

Wellstar Health System, Inc. in Georgia is seeking a Billing and Claims Specialist I to manage claim processes, submit clean claims, and follow up with payers using Epic EMR and external scrubbers.

You will work to maximize revenue, minimize denials, and ensure billing accuracy. This role requires at least 1 year of medical billing experience, familiarity with Medicare/Medicaid, CPT/ICD-10 coding, and strong communication with providers and patients.

Qualifications

• 1 year medical billing experience
• Experience with Medicare/Medicaid billing
• Knowledge of CPT and ICD-10 coding systems

Responsibilities

• Prepare and submit clean claims to third party payers electronically or by paper
• Analyze and resolve claim submission edits and payer rejections
• Follow up on denials and ensure timely reimbursement
• Maintain documentation in patient accounting system and ensure HIPAA compliance
• Review and resolve external edits from clearing houses and system queues

Skills

Medical billing

CPT/ICD-10 coding

Patient communication

Time management

Problem solving

Teamwork

Education

High School Diploma / GED

Tools

Epic EMR

Clearinghouse (Change Healthcare)

Job description

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Work Shift Day (United States of America) Job Summary: The Billing and Claims Specialist I manages claim processes, including accurate and timely claim creation, follow-up and correspondence with providers, insurance inquiries/correspondence. Processes paper and electronic claims to payers with complete information to satisfy and facilitate claim for payment. Responsible for working claim edits within Epic EMR and external claim scrubber edits prior to final submission. Also responsible for working claims rejected by payers, retro adjudicated claims needing review, as well as claims requiring an internal claim number for processing. Assists in clarification and development of process improvements and inquiries. Assures payments from all sources are recorded and reconciled timely to maximize revenues and minimize denials.

Core Responsibilities and Essential Functions

Billing and Claims

• Prepares and submits clean claims to third party payers either electronically or by paper.
• Analyze, research, and independently resolve claim submission edits and payor rejections by obtaining information from the medical record and applying CMS rules and regulations, CPT coding guidelines, and departmental policies and procedures relative to claim submission.
• Works with clearinghouse, Change Healthcare, including appropriate follow-up and with support issues.
• Coordinate process of patient eligibility through various third-party sources.
• Ensure all billing activity on accounts is documented and explained in the appropriate fields in the patient accounting system.
• Identifies and resolves patient billing issues.
• Denial and insurance follow-up management.
• Attach documentation when required by payor for claim processing.
• Consistently meet the current productivity and quality standards in processing daily electronic and/or paper claims to payers.
• Issues adjusted, corrected and/or rebilled claims to third party payers.
• Identify opportunities for system and process improvement.
• Follow Joint Commission and outside regulatory agencies mandated rules and procedures.
• Maintains strictest confidentiality, adheres to all HIPAA guidelines/regulations.
• Follow the Wellstars general Policy and Procedures, the Departments Policy and Procedures, and the Emergency Preparedness Procedures.
• Perform other duties and responsibilities as assigned.
• Resolve payer rejections, ICN claim errors, resolve Master File errors, Retro Review (Visit Filing Order Updates), and any Transfer work queue assignments.
• Add attachments and mail paper claims.
• Resolve Miscellaneous work queue errors.
• Review and override external edits from clearing house.
• Complete Railroad Medicare Claim Submissions.

Professional Communication

• Maintain confidentiality in matters relating to patient/family.
• Assure patient privacy and confidentiality as appropriate or required.
• Ensure minors have a parent or guardian listed as guarantor as appropriate.
• Interact with patients/families with a variety of developmental and sociocultural backgrounds.
• Provide information to patients and families to reduce anxiety and convey an attitude of acceptance, sensitivity, and caring.
• Maintain professional relationships and convey relevant information to other members of the healthcare team within the facility and any applicable referral agencies.
• Initiate communication with peers about changes and procedures.
• Relay information appropriately over telephone, email, and other communication devices.
• Interact with internal customers including HIM, Revenue Integrity, Patient Access, and Patient Financial Services in a professional manner to achieve revenue cycle department AR goals and objectives.

Teamwork

• Assist with special projects as assigned.
• Work closely with other staff, co-workers, peers, and other members of the healthcare team to ensure a positive and effective work environment.
• Report to appropriate personnel regarding assignments, projects, etc.
• Initiate problem solving and conflict resolution skills to foster effective work relationships with peers.
• Report to work on time and as scheduled.

Professional Development

• Attend staff meetings, in-services, and continuing education.
• Assist in the development of indicators, thresholds, study methods, and data collection as assigned.
• Respond to problems/opportunities to improve care/customer service.
• Support involvement in system performance improvement initiatives.
• Participate in and maintain competencies required for the position and specific unit/area(s) of assignment.
• Performs other duties as assigned
• Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more. Nationally ranked and locally recognized for our high-quality care and inclusive culture, Wellstar is one of Georgia’s largest and most integrated healthcare systems. Every day, 24,000+ of us work together to provide personalized care for patients at every age and stage of life – and our team members are the foundation of that care.

Required Minimum Education

High School Diploma / GED

Required Minimum License(s) and Certification(s)

All certifications are required upon hire unless otherwise stated.

Additional License(s) and Certification(s)

Required Minimum Experience

Minimum 1 year medical billing experience, including knowledge of billing related reporting.

Required or Experience working with medical payers including Medicare, Medicaid, and commercial insurance.

Required or Working knowledge of CPT and ICD-10 coding systems.

Required Minimum Skills

• Knowledge of medical billing and collection practices required.
• Works well with deadlines and is results oriented.
• Good communication skills and customer service skills when interacting with patients, co-workers and physician practices.
• Strong problem solving and analytical aptitude.
• Excellent time management skills and capacity to work independently.
• Ability and willingness to exhibit behaviors consistent with standards of performance improvement and organizational values (e.g. financial responsibility, safety, partnership and service, teamwork, compassion, integrity, trust and respect.)

Mission, Vision & Values

OUR MISSION

To enhance the health and well-being of every person we serve.

OUR VISION

Deliver world-class healthcare to every person, every time.

OUR VALUES

• We serve with compassion
• We pursue excellence
• We honor every voice
• Culture of Excellence

Wellstar consistently receives attention and accolades from national organizations that set the standards for world-class care. Our system-wide practice of safety principles, assessing and addressing errors and seeking feedback from our patients and customers continually earns recognition for advances in safety and quality. Featured on the FORTUNE “100 Best Companies to Work For” list and Seramount 100 Best Companies list, we not only provide top‑notch care for our patients, but also foster the culture of Wellstar as a Great Place to Work.