Billing Specialist I - PB

Phelps Health; United States; On-site; USD 42,000 - 56,000; Full time

Job summary

Phelps Health is a 2000-employee-strong hospital and healthcare system serving the heart of small-town Missouri. The Billing Specialist I role focuses on collecting and entering claims, posting insurance, submitting claims, and addressing patient inquiries on accounts.

Reports to the Billing Supervisor and ensures HIPAA compliance in all handling of information. Essential duties include claim entry, submission, appeals preparation, follow-up with insurers, and routine patient communications.

Qualifications

• High school diploma or GED required.
• Medical billing experience preferred.
• Experience with billing software and electronic data submission preferred.

Responsibilities

• Enters information necessary for insurance claims such as patient, insurance, and insurance ID.
• Submits insurance claims to clearinghouse or insurance companies electronically or via paper UB04 and CMS-1500 forms.
• Answers patient questions on balances, copays, deductibles, write-offs, and explains why services are not covered.
• Follows up with insurance company on unpaid or rejected claims and re-submits as needed.
• Prepares appeal letters to insurance carriers when claims are denied and gathers supporting information.
• Follows HIPAA guidelines in handling patient information.
• May perform soft collections for past-due accounts via phone or mail.
• Verifies patient benefits eligibility and coverage as needed.
• Prepares and submits secondary claims after primary processing.

Skills

Medical billing

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.

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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.

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

• N/A

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.