Billing Specialist I - HB | 1.0 FT

LE01 Phelps County Regional Medical Center; United States; On-site; USD 38,000 - 48,000; Full time

Job summary

Phelps Health in Missouri is seeking a Billing Specialist I to join our hospital and healthcare system. The role focuses on collecting and entering claims, posting payments, and answering patient inquiries about accounts.

Reporting to the Billing Supervisor, you will handle insurance claims, follow up on unpaid or denied claims, prepare appeals, and ensure HIPAA compliance while supporting patients through the billing process.

Qualifications

• High School Diploma or GED required.
• Medical billing experience highly preferred.
• Experience in billing software and electronic data submission preferred.
• Ability to follow HIPAA guidelines in handling patient information.

Responsibilities

• Enters information necessary for insurance claims such as patient, insurance, and insurance ID.
• Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper UB04 and CMS-1500 forms.
• Answers patient questions on patient responsibility portions, copays, deductibles, write-offs, etc.
• Follows up with insurance company on unpaid or rejected claims; re-submits claims.
• Prepares appeal letters to insurance carriers when not in agreement with claim denial.
• Verifies patient benefits eligibility and coverage as needed.
• Prepares and submits secondary claims upon processing by primary insurer.
• Follow HIPAA guidelines in handling patient information.
• May perform 'soft' collections for patient past due accounts.

Skills

Medical billing

Insurance claims processing

HIPAA compliance

Patient inquiries handling

Education

High School Diploma or GED

Tools

Billing software

Electronic data submission

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.

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

Certification/License

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.