Billing Services Specialist — Claims & Denials Expert

Saint Peter's Healthcare System; Piscataway Township (NJ); On-site; USD 40,000 - 55,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

401(k) match

Tuition assistance

Free onsite parking

Back-up daycare

Employee recognition rewards

Job summary

Saint Peter's Healthcare System is seeking a Billing Services Representative in the Business Office to manage account accuracy and daily claim reviews. You will monitor coding, payments, and provider billing rules, while resolving issues with payors and departments to ensure timely submissions.

Applicants should have 1+ year of medical billing experience, strong Excel/Word skills, and the ability to work with diverse teams under HIPAA and federal guidelines. Competitive benefits provided.

Qualifications

• Requires 1+ years experience as Medical Insurance Biller or related responsibilities.
• Proficient in Microsoft Word and Microsoft Excel.
• Strong interpersonal skills to work with Patient Accounts Personnel and outside agencies.
• Knowledge of Collection, A/R follow-up and Billing; familiarity with third-party payers and government agencies.
• Ability to meet deadlines and pay attention to details.

Responsibilities

• Ensure account accuracy.
• Review daily claims to ensure submissions are clean and timely.
• Monitor charges/modifiers/CPT-4s/HCPCS/payments/DRGs/ICD-10 coding.
• Review outstanding accounts using ATB/queues/payments reports/halt report/electronic billing edits/credit balances.
• Submit timely and accurate adjustments/notes/patient balance transfers and medical record requests.
• Work with management team and notifying of notifying of issues that arise with payors/departments/etc
• Resolve account issues and problem solving independently whenever possible.
• Use technology provided (including hospital information system, contract management system, electronic billing system, payer websites and document imaging system.)
• Manage denials and appealing administrative claims.
• Understand denials and how they should be handled.
• Send clinical denials and downgraded claims to appropriate parties to ensure timely appeal.
• Ensure claims denied at time of billing are distributed to appropriate parties for review.
• Update and correct accounts with assistance of originating departments (charges/authorizations/insurance issues).
• Follow departmental and hospital policy and procedure (this includes HIPAA guidelines and Federal guidelines).
• Understand payor contracts and billing guidelines; revenue codes and payor specific requirements; and payor/plan codes.
• knowledge of Medicare and Medicaid

Skills

Interpersonal skills

Attention to detail

Time management

Attention to detail

Team leadership

Tools

Microsoft Word

Microsoft Excel

Payer websites

Document imaging system

Job description

Saint Peter's Healthcare System is seeking a Billing Services Representative in the Business Office to manage account accuracy and daily claim reviews. You will monitor coding, payments, and provider billing rules, while resolving issues with payors and departments to ensure timely submissions.

Applicants should have 1+ year of medical billing experience, strong Excel/Word skills, and the ability to work with diverse teams under HIPAA and federal guidelines. Competitive benefits provided.