Billing Specialist 1 - PB | 1.0 FT

LE01 Phelps County Regional Medical Center; United States; On-site; USD 40,000 - 60,000; Full time

Job summary

Phelps Health in Rolla, MO is seeking a Billing Specialist I to manage claims from entry to submission, post-insurance activities, and patient inquiries. The role reports to the Billing Supervisor and emphasizes accuracy and HIPAA compliance.

You will work with insurance carriers, verify benefits, handle denials or resubmissions, and assist with secondary claims to ensure timely payments. Join a hospital system serving south-central Missouri with a mission to provide high-quality care.

Qualifications

• High School Diploma or GED required.
• Medical billing experience highly preferred.
• Experience with billing software and electronic submission preferred.
• Ability to handle patient inquiries and maintain HIPAA compliance.

Responsibilities

• Enters information necessary for insurance claims and verifies details.
• Submits insurance claims to clearinghouse or insurers electronically.
• Answers patient questions on balances, copays, deductibles, and write-offs.
• Follows up on unpaid or rejected claims and resubmits as needed.
• Prepares appeal letters for claim denials and collects information.
• Maintains HIPAA compliance in handling patient information.
• Assists with secondary claims after processing by the primary insurer.

Skills

Medical billing

Insurance claims

Patient inquiries

Education

High School Diploma or GED

Tools

Billing software

Job description

Phelps Health is a 2000-employee-strong hospital and healthcare system serving the heart of small-town Missouri. No matter where you start with us, we’re committed to taking our team to the top. If you’re ready for the challenge of providing life-saving care or supporting those who do, read on to find your fit in the Phelps Health family.

General Summary

The Billing Specialist I is responsible for collecting and entering claims, post insurance, submit claims, and answer patient inquiries on accounts. Reports to the Billing Supervisor.

Essential Duties and Responsibilities

• Enters information necessary for insurance claims such as patient, insurance, and insurance ID.
• Insures claim information in complete and accurate.
• Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper UB04 and/or CMS-1500 form.
• Answers patient questions on patient responsible portions, copays, deductibles, write-off's, etc. resolves patient's complaints or explains why certain services are not covered.
• Follow up with insurance company on unpaid or rejected claims.
• Resolves issues and re-submits claims.
• Prepares appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany letter.
• Follows HIPAA guidelines in handling patient information.
• May perform "soft" collections for patient past due accounts. This may include contacting and notifying patients via phone or mail.
• Understand managed care authorizations and limits to coverage such as number of visits.
• Verify patient benefits eligibility and coverage as needed.
• Prepares and submits secondary claims upon processing by primary insurer.

Standards of Behavior

• Integrity: I believe in being personally accountable for doing what is always right.
• Compassion: I believe in acting on the empathy felt toward the needs of patients and families.
• Innovation: I believe in being inspired to provide care in new and creative ways.
• Philanthropy: I believe in being a good steward of the gift of time, deeds and resources for our patients and community.

Job Qualifications

• Education: High School Diploma or GED required.
• Work Experience: Medical billing experience highly preferred. Experience in billing software and electronic data submission preferred.
• Certification/License: (none specified)
• Mental/Physical Requirements: Ability to receive and express detailed information through oral communications, visual acuity, and the ability to read and understand written directions. Normal mental concentration with repetitive operations for a long period of time. Ability to stand, walk, sit, and reach. Occasionally lifts and transports items weighing up to ten (10) pounds.

Working Conditions

• Standard office conditions with more than average noise. Periodic contact with conditions such as fumes, noise, chemicals, hazards, and/or diseases.

At Phelps Health, we think we have a better team, benefits, and opportunities for growth than anyone else around, and we invite you to see for yourself!

Phelps Health serves over 200,000 residents in south-central Missouri. Phelps Health is county-owned, non-tax supported and is overseen by a five-member elected board. Phelps Health employs more than 1,900 people, including 100-plus providers. Phelps Health, which includes a hospital licensed for 240 patient beds, serves a six-county area, with its main campus and several clinics located in Rolla, Missouri. Phelps Health also has clinics in Salem, St. James, Vienna and Waynesville, Missouri.